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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• Sampling Date: <br /> Site: I Project No. : 1-7 Lt <br /> a,3Se Well Designation: M W <br /> Is setup of traffic control devices required? ii-b Y S time: hours <br /> Is there standing water in well box? NO Above TOC Be C <br /> Is top of casing cut level? NO If no, see remar s <br /> Is well cap sealed and locked? NO iCS If no, see remarks <br /> Height of well casing riser (in inches) : y <br /> Well cover type: 8" UV12" LTV 12" EMCO_ 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent 4Z'8)# Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer _Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposable bailer:-2L— Teflon bailer: <br /> Well Diameter: 2" 4+1 6ee Sit <br /> Purge Vol. Multiplier: 0. 16 0. 6655 1. 47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />• Time: 717 Time: G23 Calculated purge: <br /> Depth of well: g'4�1J Depth to water: z;!116 _ Actual purge: 66.1 <br /> Depth to water: M?41 <br /> Start purge: ?S6 Sampling time: 93 �j <br /> Time Temp. E.C. pH Turbidity Volume <br /> 9 114 4�3 LL <br /> )-2 673 <br /> X30 <br /> 626 1 <br /> Sample appearance: cia-11 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 />