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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: <br /> q, „_,,J,,,,�, _ Sampling Date: 6-�)-- <br /> __ <br /> Site: Project No. : <br /> • y49O Well Designation:.141 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 9 YES Above TOC Below TOC <br /> Is top of casing cut level? NO V0 If no, see remarks <br /> Is well cap sealed and locked? O yea If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI_.Y � 36" CNI her <br /> General condition of wellhead assembly: Excellent Gg564 G64Fair Poor <br /> Purging Equipment: A, _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"_,Y _ 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: S 142 Time: r5R' Calculated purge: �. <br /> . Depth of well: 3 iM Depth to water: i L6.0 0 Actual purge: <br /> Depth to water: 57 /01 <br /> Start purge: L,6 Sampling time: d� <br /> Time Temp. E.C. pH Turbidity Volume <br /> La I 7J2: <br /> Sample appearance: _r- 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 />• <br /> Signature: <br />