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I , <br /> ` DOULOS ENPLRONXENTAL COMPANY - SAMPLING INFORMATION SHE'E'N <br /> .• Client : Sampling Date; <br /> i Site • r Project No. ,.- <br /> Well <br /> o. :Well Designation; <br /> i Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 9 S Above TOC Below TOC <br /> is top of casing cut level? NO If no, see remarks <br /> is well cap sealed and locked? N0� If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> well cover type; <br /> Xe; 8'" UV 1211 UV �12" EMCO 8 " BK <br /> 1211 BK 12" DWP 1211 CNI 361' CNI ther d')1.10 t t r-, <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 /> 41' PVC bailer ,Centrifugal pump <br /> r <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" g" <br /> Purge Vol . Multiplier: 0 , 16 0. 65 1. 47 2 . 61 gal/ft <br /> • <br /> Calculated purge: <br /> Time; / - _ Time: - Jam_ <br /> Depth of well ,-�gDepth to water: Zr • Z Actual purge . - 4-- <br /> Depth to water: Z 2 <br /> Start purge : l Z-r Sampling time: <br /> Time Temp.... E.C. pH Turbidity Volume <br /> ?"73 <br /> 3 -�- -- <br /> ,� 7 4/.3 ,---_ . <br /> w, <br /> Sample appearances Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced _te= <br /> 2 " Locking Cap: Lock #3753 :••,_„^_ 7/32 Allenhead : <br /> 4 " Locking Cap: Lock-Dolphin:� 9/16 Bolt : <br /> i 6" Locking Cap: Pinned Allenhead (DWP : <br /> • Remarks : <br /> S icMature : <br />