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DOULOS ENVG�IRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client. 21 t , _ Sampling Date. ; <br />• Site : 6 Project No <br /> �-z ! a1rnC Well Designation: <br /> Is setup of traffic control devices required' YES time• hours <br /> Is there standing water in well box? N YES Above TOC Below Toc <br /> Is top of casing cut level's NO If no, see remarks <br /> Is well cap sealed and locked'' NO E If no, see remarks <br /> Frelght of well casing riser (in inches) : <br /> well cover type : $" UV 12" UV 12" EMCO 8" BK� <br /> 12 " BK 1211 DWP_,-,___`_„ CNI6" CNI ther <br /> General condition of wellhead _� 3sembly: Excellent oo Fair Poor <br /> Purging Equipment : 2" disposable bailer x Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> ^41" PVC bailer Centrifugal pump <br /> i <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2"_z 411 6" 8" <br /> Purge Vol Multiplier: 0 , 16 0 . 65 1 47 2 61 gal/ft <br /> initial Measurement Recharae. Measurement <br /> Time -7 -3Time : = Calculated purge : L Z <br /> Depth of well 7�' 7 ! Depth to water: Actual purge :_�_g <br /> Depth to water:_ 3-�S <br /> Start purge Sampling time: - <br /> Time Temp . E. C. pH Turbidity Volume <br /> 1a . � `? b S- 1 0 7- � <br /> ZL <br /> f 1 oa 166--3 t / -2 --32, 2 <br /> H , 01 69 7 9`80 7- 3a <br /> A J_ <br /> Sample appearance: Lock: ' �1 <br /> Equlpment replaced : (Check all that apply) Note condition of replaced ite- <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 />