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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: r �� <br /> Site: _a/L�C.� d d Project No. : <br /> 79(76 N --91 A Well Designation: <br /> CA <br /> i <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 dM If no, see remarks <br /> Is well cap sealed and locked NO If no, see remarks <br /> Height of well casing riser (in inches) : _ �- <br /> Well cover type: 8" UV 12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP ,I,'27PNI }�.---- 36" CNI Other <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with : Disposable bailer: S P Teflon bailer: <br /> Well Diameter: 2" 4f16" 8" <br /> t <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> r <br /> Initial Measurement Recharge Measurement <br /> Time: Time : 3 3 Calculated purge: 1 S <br /> Depth of well . S` �' Depth to water: Y Actual purge: <br /> Depth to water: �I 1 <br /> Start purge: `7 /S sampling time: 7 3 <br /> s Time Temp. E. C. pH Turbidity Volume <br /> 2- <br /> -72 1- !r6 - <br /> Sample appearance: ti--- Lock: /fit <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: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) . <br /> Remarks - <br /> Signature : <br />