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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_. ,�� Sampling Date:. <br /> -3o-c)-7 <br /> Site:_R.e� 419 Pro3ect No. :_U1_11/9 '01 <br /> Well Designation: <br /> r. nn nrru n� m.�� <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? R 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) ' <br /> Well cover type: 8" W 12" UV /, 12" EMCO $" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent 6o 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 Recharge Measurement <br /> Time: Time: hrui . Calculated purge: y <br /> Depth of well : 6 ? 70 Depth to water:-- 3R-!!7 _ Actual purge: 4,10 1 . <br /> Depth to water: Y -1-,73 <br /> Start purge: M? Sampling time: //"�3 _ <br /> Time Temp. E. C. pH Turbidity Volume <br /> /3ot", 7 �. <br /> W? 0 Cclogo 2 j <br /> 11S6 6 l���5 �1If <br /> Sample appearance: Lock: <br /> w <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 />