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` DOULOS ENVIRONXENTAL COHPANY SAMPLING INFORMATION SHEET <br /> Client : , Sampling Date: 02 <br /> I � Site : Project No. : <br /> i <br /> / 6 00 Well Designation: /M s4/ - <br /> iw ina.r <br /> 1 Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES 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'+ UV12" W_ 12+' EMCO 81+ BK <br /> 1211 BK 1211 DWP 1.211 CNI 3611 CNZ Other., M CL <br /> General condition of wellhead assembly: Excellent 202!S Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump � <br /> 2+' PVC bailer Dedicated bailer <br /> 4++ PVC bailer Centrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4+1 6" g++ <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1, 47 2 . 61 gal/ft <br /> _ / Z;G// _ Calculated purge <br /> Time: /Q:15" Time; - __�T,�_ <br /> G Depth of well : Z 0,11 Depth to water: Actual purge :�0 <br /> Depth to water: <br /> Start purge . sampling time:L2<< 2• <br /> � -- <br /> � Time Temp... E. C. pH Turbidity Volume <br /> ro <br /> r <br /> r <br /> Sample appearances Lock: t <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 /> r 6++ Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> r <br /> Signature: 'r <br />