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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Ax_a,c•P, Kh:C Project <br /> • a� S , r Well Designation: R �- <br /> B- <br /> C.- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 9O YES Above TOC Below TOC <br /> Is top of casing cut level? NO Ift If no, see remarks <br /> Is well cap sealed and locked? NO Y10 If no, see remarks <br /> Height of well casing riser (in inches) : e <br /> Well cover type: 8" UV12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNIher <br /> General condition of wellhead assembly: Excellent _ ood 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: Disposal bailer: Teflon bailer: <br /> Well Diameter: 211 41r 610 810 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: G Time: 7 Calculated purge:. <br /> Depth of well: 1C1,L4U Depth to water: 6 Actual purge: U � � <br /> Depth to water:_5f•Gll <br /> Start purge: 6 O q, Sampling time: 0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 75 4d= <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead• <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: / - '_ <br />