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- <br /> bOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> • S€te Project No <br /> 2-46"D ono _ . Well Designation AA w <br /> Is setup of traffic control devices required YES time hours <br /> is there standing water to the well boxy YE Above TOC Below TOC <br /> Is top of casing cut levels 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 /> «ell cover type 8"or 12"UV 12" EMCO 8"or 12"BK 8" Christy <br /> 12 Christy 8" M&D 12"M&D 12"DWP <br /> 12 ' CNl 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer VACentrifugal pump <br /> Sampled with Disposable bailer_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> i Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> J Lninal Measurement Recharge Measurement <br /> Time G : 6 Time = Calculated purge <br /> s; S Depth of well 2 "S"' Depth to water 7 • Actual purge_ <br /> Depth to water /(, Ct s <br /> Start purge Sampling time h S <br /> L <br /> lei <br /> I;IF <br /> ;1 <br /> Time Temperature E C pH Turbidity Volume <br /> L( ; <br /> • 4 3 <br /> Sample appearance (yam Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead - <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allerihead (DWP) <br /> Remarks <br /> Signature <br />