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-1 '411111 <br /> s S, <br /> DOULOS ENPIRONXENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> Client; Sampling Date: <br />►� Site : Project No. :- <br /> ! n Well Designation: /t-Z nVD_ 2 <br /> Z_ <br /> k 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? O - If no, see remarks <br /> Is well cap sealed and locked? o3lWF if no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" UV12" UV_ 12" EMCO 8" BY <br /> 1211 BK 12" DWP 1211 CNI 3611 CNI then !p s <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 /> I <br /> Sampled with: Disposable bailer:,,_ Teflon bailer: <br /> Well Diameter: 2" 1�e 4" 6" 811 <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Time: - Time: //- U,3 Calculated purge: <br /> Depth of well: D Depth to water:, 9W, '1 / Actual purge. �- <br /> Depth to water: <br />�t Start purge: Sampling time: �I• �/ 1 <br /> Time Temp... E. C. pH Turbidity Volume <br /> 9 79" 1'7Z O --- <br /> 113 X93 �o cl �---- "� - <br /> Sample appearance: Lock: <br /> Equipment replaced; (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Look , 3753 ;_ 7/32 Allenhead. <br /> 4 " Locking Cap: Lock-Dolphin:____ 9/16 Solt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks: <br /> M <br /> Signature: <br />