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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 7 <br /> y �' <br /> Project No. : -` <br /> Site: <br /> 3 Well Designation: "" <br /> Is setup of traffic control devices required? CIV YES time:. hours <br /> Is there standing water in well box? CW YES Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 12" EMCO _ gu BK <br /> Well cover type: 8" UV 12" <br /> 12" BK 12" DWP 12" CNI 36" CNI Other_ <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer �° Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> fl�Well Diameter: 2" 4 6ff 8 ff <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 .61 gal/ft. <br /> I itial Measurement Bechar a Measurement <br /> Calculated purge: <br /> Time: q� <br /> • Depth 'of wel 1: 9 Depth to water: 4!!�S• t Actual purge: o <br /> Depth to water: <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> l l 7� ( 1 <br /> r^ C <br /> . � <br /> C- 70 <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+8 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6+1 Locking Cap:. Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />