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DOULOS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> Client: ampling Date: f 0 O <br /> Site: 7~e,�.�'E 6. Project No.: <br /> :1*Ix? W 11 Designation: /.1 t� <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? NO 4=p If no,see remarks <br /> Is well cap sealed and locked? `' NO If no,see remarks <br /> Height of well casing riser(in inches): `7 <br /> Well cover type: 8"or 12"UV 12"EMCO 8"or IT'BK 8"Christy <br /> 12"Christy8"M&D XM&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco 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 )C Centrifugal pump <br /> Sampled with: Disposable bailer x _ Teflon bailei Disposable Tubing T_ <br /> We1l Diameter: 2" 71 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recllar a Measureu lent <br /> Time: - 3 d Time: Calculated purge: <br /> Depth of well: S c? • 2 S Depth to water: Actual purge: <br /> Depth to water: y e• 0/ <br /> Start purge: /6 Sampling time: r� <br /> Time Temperature E.C. pil Turbidity Volume <br /> = f7 76 �- l2 ! ? • <br /> 0 I? I2are 7 <br /> Sample appearance: Lock: AIA' <br /> Equipment replaced: (check all that apply) I lote condition of replaced items) <br /> 2"Locking Cap: Lock: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin; 9116 Bolt: <br /> 6"Locking Cap: I linned Allenhead(DWP): <br /> Remarks: <br /> Signature: <br />