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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> . Client : Sampling Date: <br /> Site : 6 / Project No. : <br /> _,mC Well Designation : <br /> Is setup of traffic control devices required? YES time <br /> Is there standing water in well box? hours <br /> YES Above TOC Below TOC � <br /> Is top of casing cut level? No <br /> Is well cap sealed and locked? If no, see remarks <br /> Height of well casingriser NO E If no, see remarks <br /> (in inches) : 3 <br /> Well cover type : 8" W 12" UV 12" EMCO <br /> 12 " BK I2 " DWP 12" CNI 8" BK <br /> General condition of wellhead assembly: Excellent ootherFa�rL� <br /> oor <br /> Purging Equipment : 2'f disposable bailer Submersible pump <br /> 2 PVC bailer <br /> 4" PVC bailer Dedicated bailer <br /> Centrifugal pump <br /> Sampled with : Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4x 6,! 8 I <br /> Purge Vol Multiplier: 0 16 0. 65 1 47 <br /> . nit al Measurement 2 . 63 gal/ft <br /> Time 71eC 'a e easurement <br /> Time : 3 � Calculated purge �- <br /> Depth of well . S`/4' �/O Depth to water: S /,5) <br /> ._ { �� Actual purge <br /> Depth to water <br /> Start purge . 2 Sampling time: f�? <br /> Time Temp. E C. pH Turbidity Volume <br /> 9 - t -3 6 2 3 /oelO 1/4� _----� <br /> - 2 / oS 7 ,1 --------- 2 <br /> 7 • la 3 <br /> Sample appearance: cvL_ Lock <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock 13753 : <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 />