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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: ( .�- _ Sampling Date: <br /> Site: .710 a 13 a Project No. : <br /> Well Designation; - 7 <br /> Is setup of traffic control devices required9 YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO <M If no, see remarks <br /> Is well cap sealed and locked? NO ES 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 12 " CNI 36" CNI other_I #1_- C7 C d <br /> General condition of wellhead assembly: Excellent <2?R5!5 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: S #40_ Teflon bailer. <br /> $ Well Diameter: 2" 4" 61' 811 <br /> # I <br /> ? Purge Vol. Multiplier: 0 . 1.6 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar e Measurement <br /> Time: yl Time : `� Calculated purge: <br /> Depth of well - 7 q Depth to water: 9S Actual purge t S ' <br /> Depth to water: rL <br /> # Start purge : cg Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 5�o <br /> Sample appearance: �- c.� , 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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks - <br /> signature- <br />