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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> s <br /> Site: Project No. : Al 14P-IC7 � <br /> goo �S t--��1 Well Designation: W�A <br /> Is setup of traffic control devices required? `i8 YES time: hours <br /> Is there standing water in well box? to YES Above TOC Below TOC <br /> Is top of casing cut level? NO 'i:E, If no, see remarks <br /> Is well cap sealed and locked? 0 Yg If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV12" CO 8" BK <br /> 12" BK 12" DWP 12" CNI -3- I CNI her, <br /> General condition of wellhead assembly: Ex <br /> 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 bai.l.er:�.. 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: _ 0 Time: Calculated purge:- <br /> 5 <br /> Depth of well: 6 � <br /> F-OS Depth to water: .Z Actual purge: 2 S <br /> Depth to water__ 6. 7 <br /> Start purge: l �3-LJ Sampling time: 2- 3S <br /> Time Temp. E.C. pH Turbidity Volume <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 />