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r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION !SHEET <br /> Client ; IC sampling Date: � �� S� C' <br /> Site • Project No. : <br /> n Well Designation:_ — <br /> Z_ 5f A <br />` Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? elfo 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" W 12" W 12" EMCO 8" BK X <br />' 12 " BK 12" DWP 12" CNI 36" CNI Other <br /> 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 bailer Centrifugal pump <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 /> initial Measurement <br /> Time : ear"� Time: p Calculated purge: <br /> Depth of well : d � l Depth to water: ' O Actual purger <br /> Depth to water: <br /> w <br /> : Start purge : 2 ; 32 Sampling time: <br /> ,1 <br /> 1 ' <br /> Time Temp.., E.C. pH Turbidity Volume <br /> 3 3 � 7 . 1 � °l � � •2 �- � <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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks <br /> Signature . <br />