Laserfiche WebLink
DOULOS ENVIRONMENTAL COMPANYT <br /> SAMPLING INFORMATION SHEET <br /> Client: , Sampling Date: 7 -`� - <br /> :� site: Project No. ; <br /> ' /idOO Well Designation: <br /> 3 <br /> Is setup of traffic control devices required? YES time: hours <br /> 1 Is there standing water in well box? 8 YES Above TOC Below TOC <br /> Is top of casing cut level? NO QfSp 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" W 12" TN_ 12" EMCO 81' BX� <br /> 12" BK 12" DWP 12" CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent o 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: 2"-r& - 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> e s <br />� Time: C) Time;_// Calculated purge: d C-) <br /> Depth of well : �d -1 Depth to water: 9Actual purge: . D <br /> Depth to water: *7 6 <br /> T Start purge: Sampling time: 10 2 <br /> Time Temp,, E. C. I pH Turbidity Volume <br /> 111 -01 .0 7 S i 17 - / <br /> 111 . tol4,1 • 4 � yv 7 • l� <br /> Sample appearance: <br /> Lock: PEquipment replaced:replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap; Lock 13753 : 7/32 Allenhead. <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: _ Pinned Allenhead (DWP) : <br /> . Remarks : <br /> Signature : <br />