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f <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: <br /> 1 Project No. : <br /> f n Well Designation: w` <br /> 4 <br /> Is setup of traffic control devices required? % YES time: hours <br /> Is there standing water in well box? fq) YES Above TOC Below TOC <br /> Is top of casing cut level? NO UA If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK, _ <br /> 12" BK 12" DWP_ 12" CNI 36" CNI ther <br /> 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 />► <br /> Sampled with: Disposable bailer;–L—p p Teflon bailer: <br /> Well Diameter: 2"_ 4" 6" s" <br />► • Purge Vol . Multiplier: 0. 16 0. 65 1.. 47 2 . 61 gal/ft . <br /> InitU. asurement RechArae Meas2rement <br /> Time: Time:_ „(D -31 <br /> Calculated purge: 5 <br /> Depth of well : ,7 Depth to water: ? I Il Actual purge . -5-J 1 <br /> Depth to water: `9,51 <br /> start purge: I d/_5 sampling time: 14.LJ <br /> Time Temp. E. C. pH Turbidity Volume <br /> Io/6LK4313 i I <br />! X0/7 1 6 r 6 12- 71 <br /> 1101F 66 /�44 73 3 <br /> k <br /> Sample appearance: c 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 /> I 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> r <br /> AZ <br /> Signature : <br />