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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 6( 2 r� <br /> Site : 13 a Pro3ect No. : <br /> 7106 Al A Well. Designation: <br /> G A ,, <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? NO erYv-Ev-'% If no, see remarks <br /> Is well cap sealed and locked' NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV__j _ 12" EMCO 8" BY <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent <gfD Fair Poor <br /> Purging Equipment: 211 disposable bailer _Submersible pump <br /> 21" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S Teflon bailer: <br /> Well Diameter: 2" 4" 611 811 <br /> f <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> rInitial Measurement Recharge Measurement <br /> Time: 4 Time : :20 3 Calculated purge:_6 y <br /> Depth of well : S Depth to water: L( Actual purge: <br /> Depth to water: <br /> Start purge:. e f' Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 6' X14 <br /> 70 0 6 ) - $ 1 2 q / 2 ----- -3 <br /> Sample appearance: Lock: 441 kjTT- P_ <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 /> 61' Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />