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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> �� <br /> Client _ zt\1a Q1^1.-1 Sampling Date <br /> Site - 6!2/ _ ._ Pro3ect No. <br /> Well Designation : VW 3 <br /> G <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? ES Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked" NO/ If no, see remarks <br /> Height of well casing riser (in inches) . <br /> 12 <br /> Welltype : DW8 it P UV 1211 LTV 1211 EMCO 8" BK <br /> �� " yCNIX� 36" CNI Other <br /> General condition of wellhea $ssembly: 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:_ Teflon bailer. <br /> Well Diameter: 211_ 4+1 6" 8r, <br /> 0 Purge Vol Multiplier: 0 . 16 0 65 1 47 2 61 gal/ft <br /> initlal Measurement Rechgrge Measurement <br /> Time -7 Time: Calculated purge <br /> Depth of well , f y 951 Depth to water: V-r- Actual purge <br /> Depth to water yy d R <br /> Start purge 1 Sampling time : <br /> Time Temp. E C. pH Turbidity Volume <br /> Te G2 ' _706- 7 // -------W <br /> Sample appearance : Lack <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" 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 />