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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : U"-Ve.4 ,-„ _ Sampling Date: � �L ~ f.� <br /> Site 1 6 Project No <br /> ?�L Well Designation- <br /> Is setup of traffic control devices required' � YES time • <br /> Is there standing water in well box? hours <br /> Is top of casing cut level? YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO � If no, see remarks <br /> Height of well casing riser (in inches) : NO If no, see remarks <br /> Well cover type: 8" UV 12" UV ) 12'EM 0 <br /> 12 " By 12" DWP 8 BK <br /> 12" CNI 36" CNI Other _PO Co <br /> General condition of wellhead assembly: Excellent oo 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�P Teflon bailer <br /> Well Diameter: 2"-z- 411 6,r 811 <br /> Purge Vol Multiplier: 0 . 16 0 . 65 1 . 47 2 61 gal/ft <br /> Initial Measureme t Rech r eeasurement p <br /> Time 2 Time: 9 O Calculated purge 3 <br /> Depth of well . 7 �Fo Depth to water: o Actual purge <br /> Depth to water: Ll 3 <br /> Start purge 2 o Sampling time: jL 3 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7 - -3 / �--� <br /> x•23 66 - � � � / � Z� � 3 <br /> 26 <br /> Sample appearance: Lock: <br /> Equipment replaced - (Check all that apply) Note condition of replaced iter <br /> 2„ Locking Cap : Lock #3753 : 7/32 Allenhead - <br /> 4 Locking Cap: Lock-Dolphin: <br /> 6" Locking Cap: 9 16 Bolt . <br /> pinned Allenhead <br /> (DWP) <br /> Remarks <br /> Signature <br />