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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • G' <br /> Client : Sampling Date: p� <br /> Site- ProDect No <br /> y 1'C <br /> Well Designation. MW- I <br /> Is setup of traffic control devices required? <f_f�) YES time hours <br /> Is there standing water in well box' 4M YES Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is well cap sealed and locked' NO If no, see remarks <br /> Height of well casing riser (in inches) - <br /> Well cover type 8" UV 12 '1 W _ 12 " EMCO 8'" BK <br /> 22 " BK 12" DWP 12" CNS 36" CNIOther <br /> General condition of wellhead assembly- Excellent _.'!! o70) Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer <br /> Dedicated bailer <br /> 411 PVC bailer x _Centrifugal pump <br /> Sampled with: . Disposal bailer: Teflon bailer- <br /> Well Diameter: 2 11_�_ 4 611 811 <br /> Purge Vol multiplier. 0 16 0 . 65 1. 47 2 . 61 gal/ft . <br /> Initial Measurement Recharge Measurement <br /> Time 1199 Time: �q Calculated purge: f'�i <br /> "�Depth of well . f, Depth to water:A� , /3 Actua 1 purge, 1/,- ,J <br /> epth to water _ f�,�q <br /> Start purge 3 Sampling time• <br /> Time Temp. E C. pH Turbidity Volume <br /> ')-5- 7 6 <br /> � 5 z 2-z 0-6 6 3 <br /> Sample appearance: Lock. <br /> Equipment replaced ; (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap- Lock #3753 • 7/32 Allenhead <br /> 4 " Locking Cap. Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap. Pinned Allenhead (DWP) <br /> Remarks <br /> Signature : <br />