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DO,ULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> ClientSampling Date <br /> Site Project No <br /> Well Designation /t'Z V - <br /> Is setup Of rraffic control devices required` YES <br /> 15 there standing water in the well boxy time hours <br /> is lop of casing cut levels 3 Abovc TOC Below TOC <br /> Is well cap sealed and locked NO If no, sec remarks <br /> NO <br /> Heigh, of well casing riser (in inches) If no, see remarks <br /> Well cover type8" or 12" UV l2" Ei1dC0 <br /> WTO <br /> t2 Chris 8"or 12" BK 8" Christy <br /> CTlI ry 8" M&D 12" M&D 12" DW? <br /> l 34" CNI 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Good—, <br /> Fair Poor <br /> Purging Equipment 2" disposable bailer <br /> Submersible pump <br /> 2" PVC bailer _ Dedicated bailer <br /> _4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer <br /> Disposable Tubing <br /> WeII Diameter 2" 4>1 6„ <br /> purge Vol Multiplier 0 16 $ <br /> 65 147 <br /> [ninal Measurement 2 61 al/ft <br /> Rechar e Measurement <br /> Times1116 . —:5—)b Time J ''j. a <br /> Depth 7rowater <br /> ell _ — Calculated purge "3 <br /> Depth to water Actual purge / <br /> Depth /. <br /> Stan purge Sampling tirne 2 —*35- <br /> T,m <br /> 5—T,me Tem erature E C H Turbidit <br /> ' z <br /> 6 Volume <br /> P7 *7 <br /> ---SamDle appearance Lock Ir �� t �✓ <br /> EaUIDMent replaced (check all that apply) Note condition of replaced item(s) <br /> ?" Locking Cap Lock 7/32 Allenhead <br /> Locking Car _ Lock-Dolphin w <br /> 6" L oC<1,1g Can 9/16 Bolt <br /> P -ned allenhead (DWP) <br /> .v�arti5 - <br /> S�,nac�!re <br />