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.a. tNw+a•'"��coa5>TKa*ir.- -' <br /> 1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : 2:a ID 3 <br /> Sampling Date: <br /> AD ♦ r <br />` Site: Project No. : <br /> n Well Designation: <br /> n <br /> Is setup of traffic control devices required? No YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> is top of casing cut level? If no, see remarks <br /> is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type : 8" UV 12" UV 12 " EMCO 8" BY <br /> 12" BK 12" DWP 12 " CNI 36" CNI herTT'�DYrTy <br /> 1 General condition of wellhead assembly: Excellent Goo Farr Poor <br /> Purging Equipment; 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 Sampled with: Disposable bailer: Teflon bailer : <br /> Well Diameter: 2"X11_ 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft . <br /> initial Recharge t[easurem2nt <br /> 1 Time; - e Time: - +� Calculated purge: <br /> '"�� <br /> Depth of well. : Depth to water: Actual purge:� <br /> Depth to water: • <br />'T Start purge: ZS Sampling time: ' <br /> 1 Time Temp. . E.C. pH Turbidity Volume <br /> a l C 9 5 ,7 <br /> 1 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 /> 411 Locking Cap: Lock-Dolphin; 9/16 Bolt: <br /> 6" Locking Cap: Pinned„Alllenhead (DWP) : <br /> 1 <br /> • Remarks: <br />► Signature; � <br />