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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: ttzzSampling Date: <br /> Site: fop,, i�-•- ,5 Project No. : <br /> 100 S •�' , .rte Well Designation: A Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? O If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 1211 UV 121' EMCO 81' BK <br /> 12" BK 1211 DWP 1211 CNI 3611 CNI _ her <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> .I I ..w LI�.11 I IPl�lallpgal�� <br /> Well Diameter: 211 4" 611 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: g1D Time: -M6 Calculated purge: <br /> Depth of well: ('T. Lel/ Depth to water: 3 Actual purge: <br /> Depth to water: (RFs. L' i _ <br /> Start purge: ��S _ Sampling time:_ _)000 <br /> Time Temp. E.C. pH Turbidity Volume <br /> a <br /> 7, 41 <br /> 7 , z � 6� 2 <br /> Sample appearance: i Lock: r <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2f1 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />