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DOULOs ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: E_& ate _ _ _ Project No. : S�8 <br /> Well Designation: W`2,7 <br /> �1 <br /> Is setup of traffic control devices required? N YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO XEM If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI36" CNI Other <br /> General condition of wellhead assemb y• 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: 2114 4" 611 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: -/O'er Calculated purge: . <br /> . Depth of we11: Depth to water: d 1.5a Actual purge: ,. fes tea[ <br /> Depth to water: 61,46 - <br /> Start purge: 1611 Sampling time: I600 <br /> Time Temp. E.C. pH Turbidity Volume <br /> d 4 L r--� I <br /> 16/ 7 7rI1- I. Grp --I <br /> In/ 176 -7 16 IL <br /> Sample appearance: 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 />