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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client. 1.L&-�lc1?t-,..��'.. Sampling Date: <br /> Site - „ 6�/ _ _ Pro3ect No. . <br /> /.Z, — Well Designation _ 141 <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 lever N Above TOC Below TOC <br /> NO <br /> Is well cap sealed and locked Y If no, see remarks <br /> Height of well casing riser (in inches • NO YES If no, see remarks <br /> ) <br /> well cover type: 8" W 12" [N 12" EMCO <br /> 12 8 " BK <br /> 1112 DWP 12" CNI <br /> General condition of wellhead assembl 36" CNI Other12- �y1 �� <br /> y: Excellent eTo­o9> Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> —211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with. Disposable bailer:ff Teflon bailer: <br /> Well Diameter: 2" 4'r_x_ 611 81r <br /> Purge Vol Multiplier: 0. 16 0 . 65 1 . 47 2 61 <br /> . � t a Measurementech e easurement gal/ft <br /> Time -7 Z Time : ' SQ Calculated purge 73 <br /> Depth of well . 7Z 6a`- Depth to water: D <br /> Depth to water 3 Actual purge <br /> Start purge 3 Sampling time:—i- S <br /> Time Temp. E. C. pH Turbidity Volume <br /> 3 7 , 30 ­­­-� <br /> 6 7 .261*1 2- <br /> Sample appearance: Lock: <br /> Equipment replaced (Check all that apply) Note condition of replaced stem <br /> 2 " Locking Cap; Lock #3753 :^ <br /> 4 " Locking Cap: Lock-Dolphin: 7/32 Allenhead <br /> 6" Locking Cap: 9/16 Bolt . <br /> --- Pinned Allenhead (DWP) <br /> . Remarks . <br /> Signature - <br /> . <br />