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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> • Site: z Pro3ect No. : <br /> well Designation: <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? � If no, see remarks <br /> Is well cap sealed and locked? 0- YES If no, see remarks <br /> Height of well casing riser ( in inches) : t.0,4D <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK_�_ _ <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent qbo4 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 21" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:_, Teflon bailer: <br /> Well Diameter: 211-2L 4" 6" $" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1.47 2 . 61 gal/ft. <br /> initial Measurement Recharge Measurement <br /> Time: /3 5 IJ Time: !4 D Calculated purge: 6 <br /> Depth of well : A ?-01 Depth to water: Actual purge: > <br /> Depth to water: I <br /> Start purge: 13 ,5 Sampling time: 1406 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7� z 1 <br /> ) 366 2 0 Z 12- <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 />