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^«w.�_.� w.xY ArM NW..r4'afl .�rwa1(•h.rw-+r -+ <br /> r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : Sampling Date: <br /> Site :4622:�.. Project No. ; <br /> n Rd Well Designation: W v� <br /> Is setup of traffic control devices required? qE�YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? 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 1211 UV 12" EMCO 8" BK <br /> 12 " BK 12" DWP 1211 CNI 3611 CNI er tE <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment; 211 disposable bailer Submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 h. 411 6" 8" <br /> Purge Vol . Multiplier : 0��, 166 0. 65 1 . 47 2 . 61 gal/ft. <br /> initial Measurement Mcbam Measurement <br />` <br /> Time; ' Z / Time : Calculated purge <br /> Depth of well : Depth to water: �S• S G Actual purge: 15r-n <br /> Depth to water: <br /> '= Start purge: -'4 Sampling time; <br /> r Time Temp. E. C. I pH Turbidity Volume <br /> /-'o 1 ,3" 6 8, el 162 <br /> 1&-'0 0 190- P hs'rr7l � ---1, <br /> 19 (o. 1 <br /> ._..._.._ <br /> I I _J I <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 /> r <br /> • Remarks : <br /> r Signature: <br /> ' ' I <br />