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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client: Sampling Date:.. <br /> Site : ez. Project No. : <br /> / n Well Designation:�� w R <br /> Z It <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? cqwO ( f If no, see remarks <br /> Is well cap sealed and locked? NO J If no, see remarks <br /> Height of well casing riser (in inches) : �, <br /> Well cover type: 8'1 LTV 12'1 UV 12" EMCO 8" BK _ <br />' 12 " BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o9_cV Fair Poor <br /> Purging Equipment : 211 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: 2" 410 Bit <br /> 1 iePurge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial e s <br /> Time : Time: 3 F,. �. ., Calculated purge: <br /> Depth of well : 19 - 57 Depth to water: Actual purge. <br /> Depth to water: <br /> Start purge :_3 2 ji�r_ Sampling time: <br /> I <br /> Time Temp.. E. C. pH Turbidity Volume <br /> G8 - p ll60 . 06 . <br /> Sample appearance: Lock: <br /> Equipment 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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks . <br /> Signature : <br />