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DOuLos ENVIRONMENTAL COMPANY SAMPLING INFO41ATION SHEET <br /> `r Client: Sampling Date: l <br /> NY <br /> Site: "Yl5Project No. : <br /> Well Designation: r L <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? O If no, see remarks <br /> Is well cap sealed and locked? NO y If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: r 2" disposable bailer submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:, Teflon bailer: <br /> Well Diameter: 2"_x_ 4" 6" e" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/£t. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: .fin Calculated purge: � • <br /> . Depth of well: 7 * � Depth to water; b 3 Actual purge: <br /> Depth to water: <br /> Start purge:_ L 3g Sampling time: .'S.5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> •3� 7<9�7* 2 yl 1 <br /> 2 3 7 7_2 -2 <br /> � 2 / 7 7K- <br /> 3 7�. 1 l65 �. . q <br /> Sample appearance: 77 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 />