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1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: ~ �" <br /> 1 Site : Project No. ; <br /> 0� Well Designation; /t4 <br /> n <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 11 UV 121f W 1211 EMCO 811 BK >< <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent q2]!M5 Fair Poor <br /> Purging Equipment: 21' disposable bailer Submersible pump <br /> 211 PVC bailer ` ' Dedicated bailer <br /> 411 PVC bailer X Centrifugal pump <br /> Sampled with: Disposable bailer:-X-- Teflon bailer: <br /> Well Diameter: 211 X, 4" 611 all <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> 1 <br /> -initial e s Rer en J <br /> Time: Q , f Time: Calculated purge: S` r <br /> Depth of well : Depth to wafer: �� � Actual purge: <br /> Depth to water: q V0 <br /> 3 l6 <br /> Hf, Start purge : 3 � D Sampling time: <br /> 1 <br /> Time Temp., E. C. I pH I Turbidity Volume <br /> 3 r r 6 :3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock , 3753 : 7/32 Allenhead• <br /> 4 " Locking cap: Lock-Dolphin: 9/16 Bolt : <br /> 61' Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks : <br /> Signature . <br />