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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date x f �f-� <br /> . Site Project No <br /> L� Well Designation w <br /> 15 serup of rraffic control devices required NO YES time hours <br /> Is there standtng water in the well box9 YES Above TOC Below TOC <br /> Is iop of casing cut level? NO QFff5 If no,see remarks <br /> 1� uell cap sealed and iocked9 NO If no,see remarks <br /> Heiehi of well casing riser (in inches) <br /> '�zII co%er type 8" or 12" UV 12" MCO 8"or 12"BK 8" Christy <br /> 12 Christy 8 ' M&D 12"M&D 12"DWP <br /> 12 CNI1 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 Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> lninal Measurement Recharge Measurement <br /> Time _C� Time _ 1 2 ' Z Calculated purge <br /> Wepih of well s• 3 0 Depth to water y 10 Actual purge <br /> Depth to water <br /> Start purge Sampling time <br /> Time Temperature E C pH <br /> �/} TurbidityVolume <br /> r <br /> [ ` ` i f'] 1 �l ' T� 4 C/ <br /> g : I -)4 - 0 f ( 06 q_ (- <br /> ILZa laR 6 <br /> Sample appearance Lock Ic4V41 1 1 <br /> fix <br /> Equipment reolaced (check all that apply) Note condition of replaced item(s) _ <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> marks t <br /> Si mature <br />