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DOULOS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> i Client: Sampling Date: f / 0 — <br /> Site: <br /> rSite: -1 e- 6 769w Project No.: <br /> Well Designation: w r <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? 9ER> 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"or 12"W ' 12"EMCO 8"or 1 "BK 8"Christy <br /> 12"Christy 8 M&DX 12"M&D 12"D <br /> 12"CNI 36"CNI 12"Porneco Other: <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer >14— Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter: 2" X 4" 6" 8" <br /> Purge Vol.Multiplier: 0.16 4.65 1.47 2.61 gal/ft. <br /> Initial Measurement Rechar e Measurement' - <br /> Time: / '- -� Time: = 0 Calculated purge: <br /> •� Depth of well: ' Depth to water: dV6- Actual purge: <br /> Depth to water: 16. • D <br /> 02*� '* 0 <br /> Start purge: Sampling time: <br /> Time Tem erature E.C. Turbidity Volume <br /> 7- 3 <br /> Sample appearance: Lock: <br /> Equipment replaced:replaced: (check all that apply) Note condition of replaced items) <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />