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DOULOs ENV2RONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Y <br /> site: �i-�.,r.A.r �- ���_ Project No. •_ qU- &15-'C�� <br /> Well Designation: MW-21 <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? ro q09A If no, see remarks <br /> Is well cap sealed and locked? 0IV 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" CNI _)L _ 36" CNI _ ther <br /> General condition of wellhead assembly: Excellent (Goo 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:A-1 — 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: _ � Calculated purge:.)-)-4-ed. <br /> Depth <br /> urge: )-)- <br /> Depth of well: Depth to water: Actual purge: �-�- <br /> Depth to water: C�S..�D <br /> Start purge: 1600 Sampling time: 16b0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> fool <br /> Sample appearance: �A� 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 />