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r _ <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> i • Client: _ Sampling Date:� 0 <br /> CP- <br /> Site:l <br /> 1 _ _ Project No. :� . <br /> /E n Well Designation:- <br /> Is setup of traffic control devices required? A09 YES time: <br /> 1 Is there standing water in well box? hours <br /> Is top of casing cut level? ES Above TOC Below TOC <br /> Is well cap sealed and locked? O If no, see remarks <br /> Height of well casing riser (in inches) : NO If no, see remarks <br /> Well cover type: 8" UV 12" W 12" EMCO <br /> 12" BK 12" DWP nCNI 8 ii BK_ <br /> General condition of y: Excellent wellhead assembl36" CNI <br /> ether <br /> 1 Fair <br /> Poor <br /> Purging Equipment : 2" disposable bailer <br /> _ 211 PVC bailer Submersible pump <br /> —411 PVC bailer Dedicated baiter <br /> Centrifugal pump <br /> 1 Sampled with: Disposable bailer:--,K— Teflon bailer: <br /> Well Diameter: 2" 410 611 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Ini• t a ensu e s ent <br /> Time. Time :_ 3 . .� /�J <br /> Depth of well : �1 �� Calculated purge ,_1____7_ <br /> 7 <br /> Depth to water: • Q <br /> Depth to water: Actual purge <br /> F' Start purge:_-L ��_ Sampling <br /> I Time Temp... E. C. pH Turbidity Volume <br /> r l O <br /> -7 .0 <br /> 0/ •1 �- <br /> Sample appearance: G <br /> Lock: <br /> Equipment replaced: (Check all that apply) Note conditio of replaced item <br /> 2" Locking Cap:__ Lock , 3753 : <br /> 4 " Locking Cap: - 7/32 Allenhead, <br /> 6" Locking Cap:. Lock-Dolphin: 9/16 Bolt :�� <br />► Pinned Al lenhead (DWP) <br /> . Remarks • <br /> Signature : <br />