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w.rst.+v. ++f"�erG'•.vtrcw:r.tw1+�-arc -.ra <br /> 1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: �.�-[ter + F <br /> �..�ir„ , _ C' , Sampling Date; <br /> Site ; Project No. : <br /> /S' 00 �, PQ7 -/cin RZ Well Designation: } <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing water in well box? NO YES Above TOC Below TOC <br /> Is top of casing cut level? NO YES If no, see remarks <br /> Is well cap sealed and locked? NO q YES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" U 1.2" W 12" EMCO 8 " BK <br /> 1211 BK 12" DWP 12" CNI 3611 CHI er M( rC -T1� <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 /> 4" PVC bailer - C Centrifugal pump <br /> Sampled with: Disposable bailer:_>!::r_ Teflon bailer : <br /> Well Diameter; 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial e s <br /> 1 Time: 47 Time: Calculated purge: <br /> Depth of well , � Depth to water: Actual purge: [ <br /> Depth to water: <br /> Start purge: �C� �_ . Sampling time: &, Go <br /> Time Temp. E. C. pH Turbidity Volume <br /> Vo-,C/'7�?/ r. :!> �'Co 0 -T.—y-3 <br /> 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 /> 4 " Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> 1 Signature : <br />