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1 <br /> DOULOS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: f ` <br /> Z6"Site: e 6 6° Project No,: <br /> Well Designation: (ti <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 Ievel? NO If no,see remarks <br /> Is well cap sealed and locked? u NO If no,see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"UV 12"EMCO 8"or 1 "BK 8"Christy <br /> 12"Christy 8"M&D -VL M&D _ 12"DW <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 Centrifugal pump <br /> Sampled with: Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter: 2"_ 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61. gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: J = u 'STime: = 5 7 Calculated purge: f- 7 <br /> Depth of well: 57 Depth to water: - Actual purge: <br /> Depth to water: V7 (3 <br /> Start purge: °1 -3 d5- Sampling time: = O <br /> Time Temperature E.C. p Turbidity Volume <br /> 2 ' 32 70- © iyda 7 - 7L/ <br /> 2 - y 7 <br /> a - � �6 7 . 7 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (check all that apply) Note condition of replace item(s) <br /> 2"Locking Cap: Lock: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead(DWP): <br /> Remarks: <br /> Signature: <br />