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DOULOS EN9IRONMENTAL COMPANY SAMPLING INFORMATION SHEEN' <br /> Client: Sampling Date: a 7 <br /> ? Site; Project No. : <br />�5 , <br /> U00 POL/a/1 Well Designation: I N WO - L4 <br /> ]` <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 VM if no, see remarks <br /> Is well cap sealed and locked? NO itn> If no, see remarks <br /> Height of well casing riser (in inches) ': (0 _ <br /> Well cover type: 8" W 12" W <br /> 12" EMCO It HK <br /> 12" BK 12" DWP� 12" CNI 36" CNI Other <br /> J General <br /> 7<--J, i <br /> General condition of wellhead assembly: Excellent <M Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> -2" PVC bailer Dedicated bailer <br /> ..x,_411 PVC bailer ,Centrifugal pump <br /> 0 Sampled with: Disposable bailer:_, Teflon bailer: <br /> Well Diameter; 2"�L, -4" 611 816 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> 140 Time., X z 14 AL Time ! 2- = C? Calculated purge: 10 - <br /> Depth of well : x � © Depth to waterActual purge. <br /> Depth to water:___7- 4C <br />'T Start purge: � ' 3 3 Sampling time: S <br /> a Time Temp? E.C. pH Turbidity Volume <br /> 1L 3y G 3 , 3 / S 7 'c'J y r <br /> 2 = 36 6y / / o -7- v0 <br /> Z 3 &e'.'l 3 -- 3 <br /> 0 Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced ite= <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin:�' 9/16 Bolt: <br /> 6" Locking Cap: <br /> 1 Pinned Allenhead (DWP) : <br /> . Remarks: <br /> 1 Signature: <br />