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1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• -CftSampling Date: <br /> oes�' o-�pl� <br /> 1 Site: dA Project No. : <br /> Well Designation: N! <br /> r 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 <IMP If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" UV12" kMCO 8'T BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 General condition of wellhead assembly: Excellent QRRh 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: 211-41 4'I 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial kleapAremgnt Recharge 1124murements <br /> 1 Time: Time: Calculated <br /> purge: s' <br /> Depth of well : © ' 1 3 Depth to water: D Actual purge: SSS <br /> Depth to water: <br /> Start purge: 1 2 3 0 Sampling time: 2 3 7 <br /> 1 Time Temp. E.C. pH Turbidity Volume <br /> t2 =31 � �. . �� � • 33 � c <br /> 1 It = 33 73 . 0 <br /> 1 Sample appearance: Lock: 707 <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 /> 1 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> 1 <br /> Signature: <br />