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/ DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:_ <br /> • <br /> Site: Project No. : <br /> 1 <br /> 6 oa „�. �lahlu� Ra Well Designation: M w y 3 <br /> Z- g 11 <br /> Is setup of traffic control devices required? <1P YES time: hours <br />/ Is there standing water in well box? N YES Above TOC Below Toc <br /> Is top of casing cut level? O &4M If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing rimer (in inches) : _ <br /> Well cover type: 8" W 12'1 W 12" EMCO 8" BK � <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: _2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal. pump <br /> 1 Sampled with: Disposable bailer;—L-X` 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 su ment <br /> 1 Calculated purge: <br /> Time: o Time: <br /> Y_ <br /> _�•, , 7 <br /> Depth of well: �� '� 1 Depth to water.? Actual purge: <br /> Depth to water: <br /> } Start purge: I �' Sampling time: = �^ <br /> r Time Temp. E.C. pH Turbidity Volume <br /> 3 (100 / o <br /> o 9 3 -7 0 ---� <br /> r ( . o1 -7/ 08 7 03 <br /> r Sample appearance: el. Lock: <br /> i <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Look #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Al.lenhead (DWP) : <br /> r iRemarks : <br /> r signature : <br />