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1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: 19,Vr 1#" , / Cdar%,2,, Sampling Date: �T` 3O- O 1 <br /> Site: Project No, : <br /> 1 f <br /> 1qq1--1Q,1 Well Designation: Mw <br /> Lam., G A <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : X <br /> Well cover type: 8" UV 121' UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI _CLther <br /> 1 General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: /XX\ Teflon bailer: <br /> Well Diameter: 2" X 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> . Initial Measurement Recharae Measurement S 3 <br /> Time: q 7 3 Time: I = IV I Calculated purge: <br /> Depth of well : l r Depth to water: 1 0 Actual purge:=.:E3 <br /> Depth to water: S 77T <br /> Start purge: 3 �- Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> .9 ---� l <br /> - 3 2 "0 <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 />