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SAMPLING INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL COMPANY <br /> Client: Sampling Date: <br /> 6-13 17 <br /> Site: • <br /> Project No. ' UL `o <br /> ' Well Designation: <br /> _ <br /> Is setup of traffic control devices .required? NO YES e <br /> tim • hours <br /> TOC Below TOC <br /> Is there standing water in well box. If no, see remarks <br /> Is top of casing cut level? NO fg if no, see remarks <br /> is well cap sealed and locked? NO <br /> Height of well casing riser (in inc a�> $" BK <br /> Well cover type: $" UV -I212„ EMCO Other_ <br /> 12” BK 12" DWP 1211 'C CNI 36„ CNI Excellent oo Fair Poor <br /> General condition of wellhead assembly: <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer X_Centrifugal pump <br /> Sampled with: Disposable bailer:,/_ Teflon bailer: <br /> Well Diameter: 2" <br /> 401 x 611- <br /> Purge <br /> 1,Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement_ <br /> Time•, 7u S Time; 82-3 Calculated purge: <br /> Depth of well: S3./O _ Depth to water. 66O�E Actual purge: <br /> Depth to water: 63.05 <br /> Start purge: Sampling time: a-4 <br /> Time Temp. E.C. pH Turbidity Volume <br /> SJ5 D-4 <br /> 916 6y, <br /> SI 7 6i?, --3 a <br /> �rzo G13 <br /> Sample appearance: Lock: <br /> m ite <br /> Equipment replaced: (Check all that apply) Note condition of replaced <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 />