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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: , Sampling Date: �' �_) 7' O� <br /> Site: Project No. : <br /> QQ_ S, P0,4all Ral Well Designation: M <br /> Is setup of traffic control devices required? /�0 YES time: hours <br /> 1 Is there standing water in well box? Above TOC Below Toc <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO�E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV_ 12" EMCO 8" BK /1W_1 <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 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 /> 1 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 M s <br /> 1 Time: 0 ., Time: - Calculated purge: <br /> Depth of well: `1 ' 7 5 Depth to water; q • Actual purge <br /> Depth to water; <br /> Start purge: lC 35; Sampling time: <br /> 1 Time Temp E.C. pH Turbidity Volume <br /> 1 / 1 - 3A 63 . 0 1 <793 X7. 7 -- I <br /> If • 3 1 63 . q 7 - ?d 7 <br /> lt ( -- 39163 . I q6 3 G'G3 3 <br /> 1 J <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 /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (Dwp) : <br /> Remarks : <br /> 1 <br /> Signature: <br />