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�� ..+. i',,,.,."p�Fn."'!�"•�'+e+�'4�r/ra-^�K'�r f,5�rer+rK�.* . �.,�«....,.,,..r..... +- <br /> 5 <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> S i to Project No <br /> Zd Well Designation M w <br /> � G A - r-- - <br /> I� setup of Traffic control devices required? ® YES time hours <br /> Is There standing water in the well box? NO Above TOC cow <br /> Is lop of casing cut level? NO If no, see remarks <br /> Is ++est cap scaled and locked9 NO If no, see remarks <br /> height of well casing riser(in inches) <br /> '� 0 cover rype 8' or 12" UV 12" EMC0 8"or 12"BK 8" Christy <br /> 12 Ch:tsry 8" M&D 12" M&D� 12"DWP <br /> 12 CNI 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 �, Centrifugal pump <br /> Sampled with Disposable bailer_ Y1_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" Y-1,— 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> initial Measurement Recharge Measurement <br /> Time e S D Time JJL Calculated purge S <br /> • Depth of well Depth to water y S l Actual purge /4 <br /> Depth to water , <br /> Start purge - Sampling time JJ=:0 i <br /> Time Temperature E C H Turbidit Volume <br /> t [ -� -2 <br /> `7 9 $ S 66 <br /> '� I I ' S �. s � U • 6� 3 <br /> t <br /> Sample appearance rit�.r- 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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks �f <br /> c <br /> Signature <br /> } <br />