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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ►� Client; Sampling Date: <br />' Site : 711,1_ . eza4.a' Project No. : <br /> well Designation: w <br /> Is setup of traffic control devices required?<� YES time: hours <br /> Is there standing waiter in well box? NOAbove TOC Below TOC <br /> Is top of casing cut level? NO if no, see remarks <br /> Is well cap sealed and locked? N0(0 ES If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" UV1211 UV12" EMCO 8�" BK <br /> 12 11 BX 1211 DWP 1211 CNI 3611 CNI her 1�I�/ Ihf 0 5 <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer centrifugal pump <br /> 1 Sampled with; Disposable bailer: .. u.unTeflon bailer: <br /> n�� rr n.urr <br /> Well Diameter; 21 411 611 8}r <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measiarement Recharcregent <br /> 1 Time: . Time : ' P Calculated purge . <br /> Depth ofwell : �. Depth to water: Actual purge , <br /> Depth to water: <br /> 'T Start purge: � �� sampling <br /> 1 Time Temp. E. C. pH Turbidity Volume <br /> 7 G3 <br /> 1 Sample appearance: Lock: <br /> Equipment replaced; (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 ; " 7/32 Allenhead; <br /> 41' Locking Cap: Lock-Dolphin: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DVP) : <br /> 1 � <br /> Remarks : - <br /> i Signature : <br />