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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: r2 8 - 00 <br /> Site:__ Q� 13 a Pro3ect No. : <br /> _7_20E Al Well Designation: r� r <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 lever NO � If no, see remarks <br /> Is well cap sealed and locked? No S 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 Y�:, 12" CNI 36" CNI Other <br /> General condition of wellhead assembly. 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: Disposable bailer: '00 - Teflon bailer: <br /> Well Diameter: 2" 4" X6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharge tjeasurement <br /> Time : y A Time; Calculated purge:_� <br /> Depth of well : -7 Depth to water: Actual purge .�� <br /> ' Depth to water: <br /> Start purge: - Sampling time: C� <br /> Time Temp. E. C. pH Turbidity Volume <br /> 2 � G7 I S5 / 2 ( 1 <br /> i <br /> Sample appearance: --- Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap; Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock--Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks • <br /> Signature <br />