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l.wa.bxrw.d.r/r"'+a'{J)3sW'iP1�1'��""ity SY+ <br /> DOULOS ENVXRONXENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> Client : Sampling Date: <br /> Site : Project No. : <br /> / n Well Designation: r--J- <br /> # /- q *tft <br /> M Is setup of traffic control devices required? fty 'YES time:_ hours <br /> Is there standing water in well box? M yU Above TOC Below TOC <br /> Is top of casing cut level? NO 1f 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" W 12" UV_ 12" E4CO 8" BK <br /> 121' $K 12" DWP 12" CNZ 36" CNI ther�i 3 ft <br /> en <br /> General condition of wellhead assembly: Excellt Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _.Centrifugal pump <br /> Sampled with: Disposable bailer:..._ Teflon bailer: <br /> Well Diameter; 211 4" 6" 811 <br /> Purge Vol . Multiplier: 0, 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Time : : / Time: <br /> .'4 2 Calculated purge : <br /> Depth of well : e &- 09 Depth to water$,_Z- 7-9 Actual purge , <br /> Depth to water: • <br /> start purge : 2- 00 Sampling time: <br /> Time Temp.... E.C. PH Turbidity Volume <br /> 2 --T/ -3 "7i <br /> Sample appearance; Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced ?tem <br /> 2" Locking Cap; Lock 03753 ; 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 /> Sig-nature - <br />