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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ' Client: Sampling Date: <br /> site: F!!! ► -.4ti -�«-c , 6� Project No. : q!l 611 'S- 49) <br /> 9DD Well Designation: _.�'1�1/'� 6 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? J@ YES Above TOC Below TOC <br /> Is top of casing cut level? NO DD If no, see remarks <br /> Is well cap sealed and locked? 0 YIS If no, see remarks <br /> Height of well casing riser (in inches) : �z <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI�� 36" CNI Other <br /> General condition of wellhead assembly: Excellent �oo2 Fair Poor <br /> Purging Equipment: 11disposable 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_/]� 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial easurement Recharge Measurement <br /> Time: 5 S _ Time: cLCalculated purge: <br /> Depth of well: 0 87 Depth to wate7� <br /> r: Actual purge: / <br />*Depth to water: r, 1. L# I <br /> Start purge: 6 R sampling time: 70 <br /> Time Temp. E. C. pH Turbidity Volume <br /> a 7 1-7 <br /> "7 z 7 X1-7 �— <br /> �Q2, 7 L4 -�- <br /> Sample appearance: A`-_ . Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />