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;v ' SAMPLING INFORMATION SHEET <br /> > DOULOS ENVIRONMENTAL COMPANY <br /> Client: <br /> Sampling Date:_ <br /> Project No. : qy` <br /> Site: <br /> Well Designation: <br /> _ <br /> hours <br /> Is setup of traffic control devices�requi.red? � YES Above Below TOC <br /> Is there standing water in well box. If no, see remarks <br /> NO <br /> Is top of casing cut level? NO ME If no, see remarks <br /> Is well cap sealed and locked? <br /> Height of well casing riser . (in inches) : !� $„ BK <br /> Well cover type: 8" UV 12'1 UV�� — �� 12 EMCO CNI h r. <br /> 12" BIS 12" DWP 12" CNI ____ Excellent oo Fair Poor <br /> General condition of wellhead assembly: <br /> Submersible pump <br /> Purging Equipment: 2" �� <br /> disposable bailer Dedicated bailer <br /> 2" PVC bailer -. <br /> 4" PVC bailerCen al pump . <br /> Sampled with: Disposable bailer: Teflon bailer:_ __ <br /> Well Diameter: 2" 4 —. 611 8,+'! <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement ��,� <br /> . Time• <br /> Time: �' Calculated purge: <br /> Depth of well:_ E-0,09 Depth to water:_��? Actual purge purge: <br /> 6. <br /> Depth to water• 6-3.56 <br /> Start purge: Fr3 Sampling time: l <br /> Time Temp. E.C. pH Turbidity EVolume7 <br /> 9D1 as <br /> qa9 6 . -//o7( �Lg <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� <br /> Lock-Dolphin: 9/16 Bolt: <br /> 4 Locking Cap: p Pinned Allenhead (DWP) : <br /> 6" Locking Cap:_ <br /> • Remarks: <br /> 2 <br /> Signature: <br />