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—+...�-.�T— ..iwi SIW iiµ4�SwCt'4 ril'v141CfY1's'Mf + <br /> DOULOS ENVIRONMENTAL COMPANY _ SAMPLING INFORMATION SHEET <br /> Client: CZ02.4/-ft 4n1- Sampling Date: <br /> Site: Project No. : <br /> I � n Well Designation: <br /> tt <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? N YE Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO, S If no, see remarks <br /> Height of well casing riser (in inches) : + in <br /> Well cover type: 8" UV12" UV 12 " EMCO 8" BK <br /> 12" BK 12" DWF 12" CNI 36" CNZ her <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: LTeflon bailer : <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier; 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft . <br /> Initial Measurement e <br /> i • <br /> Time ; = � Time: .' � Calculated <br /> pgr <br /> Depth of well ; Depth to water: purge: <br /> Depth to water; • 3 <br /> '= Start purge : `a Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearances Lock: nicn <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 /> I <br /> • Remarks : <br /> I Signature : <br />