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I <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: , Sampling Date:� 7 - <br /> Site: Pro <br /> I, ect No. ;� <br /> / Well Designation: <br /> 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? 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" UV_ _ 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> I 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 bailerCentrifugalpump <br /> I Sampled with: Disposable bailer: ' Teflon bailer: <br /> Well Diameter: 2", -4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> I <br /> Initia MaagurpMent Rechar_cIA-Measurement <br /> 5 <br /> Time: Time: a = Calculated purge: <br /> Depth of well: / S Depth to water: 8 ' Actual purge: - .r <br /> Depth to water: <br />'x Start purge: 3 sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 10 G ? . J 0 g 1 7 , <br /> I <br /> 0 ,- vB o `Z _-3 <br /> a ---� <br /> �0 ' T7G �l• o /036 ? - �- � 3 <br /> I 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 /> I 6" Locking Cap; Pinned Allenhead (DW,P) : <br /> Remarks: <br /> Signature: <br />