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1 ,f <br /> DOULOS ENVIRONMENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> a <br /> Client*. Sampling Date:- 2, 9'0 � <br /> 1 � Sate: Project No. ; <br /> P0,44gn Well Designation; <br /> i <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 remarxs <br /> Is well cap sealed and locked? NO YES If no, see remar� s <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" W 12" UV12" EMCO 8" BK <br /> r 12" BK 12" DWP 12" CNS___ 36" CNI ther Mort/3 <br /> General condition of wellhead assembly: Excellent o 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 /> I <br />' Well Diameter: 211 4" 6" 8" <br /> Purge Vol . Multiplier; 0 . 16 0. 65 1. 47 2 . 61 gal/ft <br /> `i� Time: Time: ;V. 7 Calculated purge: <br /> Depth of well : f .S 7 Depth to water: t Actual purge : <br /> Depth to water: <br /> Start purge : - Z 0 Sampling time: 1 �'--_T-S <br /> Time Temp.... E. C. pH Turbidity Volume <br /> i <br /> 6009 S,S` <br /> 1 Sample appearance; Lock: Pog h r^✓ <br /> Equipment replaced: (Check all that apply) Note condition of replaced , te= <br /> 2 " Locking Cap: Lock ,j#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 />