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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: _ �� �, Sampling Date: <br />/ Site : 7--L u�. eza4� Project No. : <br /> 00 C. LQ -Iun Ro� Well Designation: /,A L'`.- '6 <br /> L h <br /> 1 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 : S" W 1211 W 12" EMco 811 BK_,, <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 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 /> 1 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 ensu ent Reg gar e Measurement .� <br /> Time . = Time: Calculated purge: <br /> Depth of well . p'O� Depth to water: Actual purge . <br /> Depth to water : <br /> r Start purge: 3 40 Sampling time:-:3 0� <br /> Time Temp. ., E. C. I pH I Turbidity Volume <br /> ,3 -, 001 10 / 7 1 7 -3 -� <br /> © I �_ 7 - 7 <br /> 1 7 T <br /> Sample appearance :ppearance : 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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks : <br /> i <br /> Signature - <br />