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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: ��C -GGi7hai'y __ Sampling Date: <br /> Site: Project No. : <br /> �� f _ �►c Well Designation: /� w <br /> CIA-- <br /> Is <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP CNI_ I— 36" CNI Other <br /> General condition of wellhead assembly: Excellent Aoo 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: 211-2-11- 4" 6" Sol— <br /> Purge <br /> "Purge Vol . Multiplier: 0 . 16 0. 65 1 .47 2 . 61 gal/ft. <br /> Initial Measurement Recharge pleasurement Q <br /> STime: = ? r� Time: Calculated purge <br /> Depth of well : r l Depth to water: 6 Actual purge. <br /> Depth to water: `1 <br /> Start purge: = Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 2- <br /> 0-6- <br /> Sample <br /> Sample appearance: Lock: <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 />