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i DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client � ,,....._. _ Sampling Date —Q� <br /> Site ,,,,.�� ,j�_ Project No <br /> L4IL <br /> Well Designation ^/!�J (/t/ <br /> f� serup of traffic control devices required9 YES time hours <br /> Is there standing water in the well boxy yEa Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> 1, ell cap sealed and locked9 NO If no, see remarks <br /> Hzight of well casing riser (in inches) <br /> }, ell cotter We 8" or 12"UV 12"EMC0 8"or 12" BK 8"Christy <br /> 12 Christy 8" M&D 12"M&D 12"DWP <br /> 12 CNN 36" CNI 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Good--X Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> Sampled with Disposable <br /> 4" PVC bailer Centnfuga] pump <br /> bailer_� e 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 /> -;; [metal Measurement Recharge Measurement <br /> Time 3 ___ Time Calculated purge 10 `f <br /> ;ts ! Depth of well g Depth to water ._ _� '_2 Actual purge 4 <br /> Depth to water <br /> r <br /> }r Start purge = Sampling time <br /> 1f, <br /> f� Time Temperature E C pH TurbiditZ Volume <br /> sf , <br /> fk' <br /> � <br /> . <br /> � <br /> Sample appearanceLock A/1 ;4-r, (z— <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> •Remarks <br /> r <br /> Signature <br /> �rI <br /> ;1 __ <br />