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l , <br /> 1 i ^ <br /> r DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> , f <br /> Client:S.�3�'��r1a.�t►���.1'�-t�3tia� Sampling Date: �]I <br /> Site : � ���1�, Project No. : <br /> 1-11 <br /> / 57t1__ Ad Well Designation: _ <br /> Z_ ro it <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level? O 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" UV 12" UV12" EMCO It BK <br /> 12 " BK 12" DWP 12" CNI 36" CNI er <br /> General condition of wellhead assembly: Excellent ood 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: Teflon bailer: <br /> Well Diameter: 2" 4" 61' 8" <br /> Purge Vol . Multiplier: 0 . 11666 0. 65 1. 47 2 , 61 gal/ft . <br /> . Initial Measugmen y <br /> Time: 7!IST Time: ' 2 Calculated purge: <br /> Depth of well ; Depth to Actual purge : <br /> Depth to water; <br /> :z Start purge: Jam - �� Sampling time: � - <br /> Time Temp, . E. C. pH Turbidity Volume <br /> f Z <br /> o w 7,5 70 ,6 - <br /> r 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 /> 4 " Locking Cap: Lock-Dolphin: 9/36 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWp) : <br /> Remarks: <br /> Signature: <br />