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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> 44111- <br /> Site: ioe,- Project No. :�Iq - �+' iQ <br /> r01 <br /> S Well Designation: <br /> C <br /> Is setup of traffic control devices required? <� YES time: hours <br /> Is there standing water in well box? <TJ-0> YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO/ If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" LV — 12 IW 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 /> Y411 PVC bailer � Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 211-4- 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial M asurement Recharge Measurement ' <br /> Time: _ Time: 4.LP5 Calculated purge: <br /> • Depth of well: Depth to water: Actual purge:-�- � <br /> Depth to water:6 9 •—- <br /> Start purge: Lt 60 _ Sampling time: L4 ' -� <br /> Time Temp. E. C. pH Turbidity Volume <br /> 4t /, 3 KZ r ,3 <br /> g'J -7 Sol_ <br /> Sample appearance: c2AAA4 Lock: <br /> Equipment replaced: (Check all that apply) Notcondition 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: Prone Allenhead (DWP) : <br /> J, <br /> Remarks: <br /> Signature: <br />