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1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: Z UP <br /> Site; Project No. : <br /> 1 <br /> / S'6QQ Pok-tun Rai Well Designation: �r <br /> L It <br /> Is setup of traffic control devices required? � YES time : hours <br /> Is there standing water in well box? Y S Above TOC Below TOC <br /> Is top of casing cut leve.? NO 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" UV12" EMCO 8" BK T <br /> 12" BK 12" DWP 1211 CNI 361' CNI e <br /> r General condition of wellhead assembly: Excellent Good Fair Poor <br /> r.ni..rrr��r .u uuiu■ i ni u. u i nr�u i � _ <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"1 411 6" 8" <br /> Purge Vol . Multiplier: 0116 0. 65 1 , 47 2 . 61 gal/ft . <br /> . initial Measegharge <br />� Time: �1 Time: Calculated purge: �- <br /> Depth of well : �`7 Depth to water: Actual purger <br /> Depth to watery:} .2 <br /> Start purge : / Sampling time: /a �'60 <br /> 1 Time Temp. E. C. pH Turbidity Volume <br /> -203 <br /> r Sample appearances 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 /> 1 <br /> . Remarks : <br /> Signature : <br />