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a <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> Site <br /> Project No <br /> Well Designation /`--t k/- <br /> Is setup of traffic control devices requrred'2 YES <br /> IS (here standing water to the well box? trme �^ hours <br /> Is cop of casing cut level? Above TOC Below TOC <br /> Is well cap sealed and locked NO If no, see remarks <br /> Hejghr of well casing riser(in inches) NO If no, see remarks <br /> Well cover type 8" or 12" W 12" EMCO <br /> t2 Christy 8" M&D 0 8" or I2" BIC 8" Christy <br /> 12 CNI 12 M&D 1211 DWP <br /> 36" CNI l2" Pomeco Other <br /> General condit2on of wellhead assembly Excellent <br /> Good Fair Poor <br /> Purging Equipment 2" disposable bailer <br /> 2" PVC bailer Submersible pump <br /> 4" PVC bailer <br /> Dedicated bailer Sampled with Disposable bailer — Teflon bailer Censrirugal pump <br /> Disposable Tuoing <br /> Well Diameter 2" 41P 6„ <br /> Purge Vol Multiplier 0 16 - 65 `�-- & <br /> 11 <br /> 1�1na-I Measurement 0 fi5 1 47 2 61 gal/fi <br /> T me Recllar e Measurement <br /> TimeCalculated u <br /> Death a�'well `�5 —� purge � . <br /> Depth to water ` .Actual purge <br /> Dcot�i co water <br /> Star ourgez" Sampling time <br /> ( Tirne Tem erasure E C H Turbidit <br /> _ Volume <br /> I 5 <br /> I <br /> Sample appearanceLocks <br /> Equipment replaced (check all that apply) Note condition of replaced itetn(s) <br /> 2" Loc''{ing Cap Lock 7/32 Allenhead <br /> " L o c'<i ng Cao �----- <br /> c" I oc'„ng Can Lock-Dolphin 9/16 Bolt <br /> P171red Allenhead (DWP) <br />