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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: C,AAl Sampling Date: <br /> Site: �/LIr ,� 13 a_ ,..,_.,,..,.._ Project No. <br /> 7926 N 9Z 4-e�JfWell Designation: '- 5 <br /> G71 it <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 levels NO 4CIf 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" W 12" UV 1.2" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other_ / 2Cd <br /> General condition of wellhead assembly: Excellent (S-TT Fair Poor <br /> �ur <br /> Purging Equipment: 2" disposable bailer x . Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: SP Teflon bailer: <br /> t Well Diameter: 211'2L 4" 6" 811 <br /> i <br /> f Purge Vol. Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Rech r e Measurement <br /> # Time: 0 Time : Calculated purge: <br /> i Depth of well : 7 2 S Depth to water: 3 6 Actual purge. <br /> Depth to water: A ). 6-1— <br /> Start <br /> 1Start purge: 5 Sampling time: S <br /> Time Temp. E. C. pH Turbidity Volume <br /> ID 6 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 21' 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 />