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1 r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> site• Project No. : <br /> 15'600 POA ,Iun Aoa Well Designation: / ' '' O _ <br /> Lot-ALam, GA ff <br /> Is setup of traffic control devices required? �YES time: hours <br /> Is there standing water in well box? E5 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" TJV 1211 EMCO11BK-- -,� <br /> 12" BK 12" DWP 12" CNI 36" CNI Other � ^,1 Q lc� / <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" 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" 8" <br /> Purge Vol . Multiplier; 0 . 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement <br /> I I = Calculated purge: <br /> S <br /> Time: Times O lltd Y <br /> Depth of well: / C, ` 3S Depth to water: 1 y0 Actual purge: <br /> Depth to water: <br /> Start purge: X-A. Sampling time: 1I �- <br /> I <br /> Time Temp. . E. C. pH Turbidity Volume <br /> 7, 10 1 <br /> II ' 2 � o - 3S *? � e1f Z <br /> 11 .12- 5 70 - � Jyv ? d L 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead; <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt. <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />