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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_ �'� Sampling Date: '7 <br /> Site: 41 _ Project No. : <br /> �-Z d E Well Designation: /�w 3 <br /> Is setup of traffic control devices required? git <br /> g YES time: hours <br /> Is there standing water in well box? YE Above TOC Below TOC <br /> Is top of casing cut level? O 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 /> Well cover type: 8" W 12" W 12" EMCO 8" BK X- <br /> 1211 BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent 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: 2"--7y" 4" 6" Bit- <br /> Purge <br /> "Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 61 gal/ft. <br /> Initial Measurement Recharcte Measurement <br /> Time : Time: Z= Calculated purge : y-! <br /> Depth ot well: -7q , 3 Depth to water: Y .31SO Actual purge <br /> Depth to water• <br /> Start purge: - � 6 Sampling time: 6 <br /> Time Temp. E.C. pH Turbidity Volume <br /> X 20 11 qo 13I � <br /> Sample appearance: e�-Ai/' Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature : <br /> 1 <br />