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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 6- <br /> Site: F,-,- ' 09 a 615' Project No. : I W - <br /> C-� � Well Designation: My- 7 <br /> Is setup of traffic control devices required? A <br /> YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? N4 If no, see remarks <br /> Is well cap sealed and locked? NO to If no, see remarks <br /> Height of well casing riser (in inches) : L/Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI� 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo 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: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1,47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: Y Calculated purge: <br /> Depth of well: x9, 61 Depth to water: Actual purge: <br /> Depth to water:fZ, 4b <br /> Start purge: Sampling time: lll�ll <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7-24 )A-0-0 2- <br /> r--� -3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" 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 />