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,.awvrri.w.Y.t�nfi's++4�k1�?us"!'r s re <br /> I <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : Sampling Date: 9.� Z <br /> r Site ; Project No. : <br /> I;�600 Well Designation:.M <br /> vid- <br /> Is setup of traffic control devices required? YES timet hours <br /> Is there standing water in well box? a YES Above TOC Below Tot <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type: 8" UV1211 UV_ 11 EMCO 8" BK. <br /> 12" BK_ 12" DWP 12" CNI ,. 36" CNI ]: th jn <br /> General condition of wellhead assembly: Excellent <tMd Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer _ 4 Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> f Well Diameter: 211,2!5;� - 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Time: Time: Calculated purge: _ <br /> Depth of we 117 3 6 Depth to� water: /O (0 C� Actual purge : <br /> Depth to water: -� <br /> Start purge• ��. ��. Sampling time: <br /> F Time Temp.... z' C. pH Turbidity Volume <br /> f <br /> o � l X30 <br /> boyZ. <br /> J160 2 /- <br /> Sample appearance: .�.Q -L ____ ._ Lock: <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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> 1 <br /> S i.gnature : <br />