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1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SFEET <br /> �iClient: Sampling Date:,_ -- <br />►� Site : Protect No, : <br /> / n Well Designation: <br /> 1 Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? cm, Y 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 rear'. - <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" UV12" W 12" EMCO 811 BK <br /> 1 12" BK 12" DWP 12'} CNI 36" CNI theyA92Pr <br /> General condition of wellhead assembly: Excellent ooFair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer:_ -_-_- Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier; 0 . 16 0. 65 1. 47 2 . 61 gal/ft . <br /> 1 • Time. 0 Calculated purge: `" �' <br /> Time: <br /> Depth of� well: f R- ?9 Depth to water: Actual purge . <br /> Depth to water: <br /> Start purge : /� .� Sampling time: �° �/. /0__ <br /> Time Temp... E. C. pH Turbidity Volume <br /> 1 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced , Lem <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead , <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt. <br /> 1 6" Locking Cap: Pinned Allenhead (DWP <br /> Remarks: <br /> 1 <br /> Signature : ' <br />