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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> ` Cl2.ent <br /> Sampling <br /> Site <br /> Pro]ect No <br /> • Well Designation Mw- <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in well box? <br /> Is top of casing cut level' YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO rM If no, see remarks <br /> Height of well casing riser (in inches) NO If no, see remarks <br /> Well cover type 8" W <br /> 12" W <br /> 12" BK 12" EMCO 8" BK <br /> Z2 " DWP 12" CNI 36" CNI Other <br /> General candztion of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment. 2 " disposable bailer <br /> Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> -4" PVC bailer - k Centrifugal pump <br /> Sampled with, Disposal bailer: Teflon bailer: <br /> Well Diameter- 2" 411 6E1 811 <br /> Purge Vol Multiplier. 0 . 16 0. 65 1 . 47 <br /> Initial Measurement Recharge Measurement 2 ' 61 gal/ft. <br /> Time ? Time: Calculated purge ` <br /> Depth of well :--4k-.)--7 Depth to water La <br /> epth to water . - � Actual purge <br /> Start purge. / Sampling time, <br /> Time Temp E. 0 PH Turbidity Volume <br /> 7 D <br /> ' 7. - 3 <br /> Sample appearance. �pn�,J Lack. <br /> Equipment replaced. (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap• Lock #3753 <br /> 4 " Locking Cap, Lock-Dolphin- 7/32 Allenhead: <br /> 6" Locking Cap: 9/16 Bolt * <br /> Pinned Allenhead (DWP) : <br /> Remarks . <br /> ---------------------- <br /> Signature <br />