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4 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ClientSampling Date: 2-30 -00 <br /> Site : 2 Project No. <br /> Well Designation:, AlIAI- _ <br /> Is setup of traffic control devices required 191)) YES time: hours <br /> Is there standing water in well box? N:Q) 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) : f3- <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK _ <br /> 12" BK 1211 DWP 12" CNI 36" CNI then <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 /> 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 Measurement Rechar a Measurement <br /> Time : Y7 Time: Calculated purge: q. <br /> Depth of well: 7S Depth to water: ��, L 3 Actual purge: �a � <br /> Depth to water: <br /> Start purge: I Lp�C� _ Sampling time: /a)-0 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 14/2 /, 15I 3 <br /> ) i4 l 71, / 4 P7 72 <br /> Sample appearance: t 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 /> ..,.--•---- <br />