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Wki _- <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> . Site Project No <br /> 2,0o'-OZ!4 9A3e_'= ,, _ Well Designation <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? ZE);W YES Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is yell cap sealed and locked9 NO E If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover rype 8" or 12"UV 12"EMCO r 12"BK8" Christy <br /> '2 Ctlrisry 8" M&D 12"M&D 12"DWP <br /> 12 CN'1 36" CNI 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PV6 bailer Centrifugal 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 /> lnival Measurement Recharge Measurement <br /> Time 6 % `{ Time , 3 Calculated purge 3 d <br /> • Depth of well - © Depth to water 6 Actual purge 30, <br /> Depth to water L/ <br /> Start purge qt7 Sampling time YO <br /> ,i <br /> Time Tem erature EC pH Turbidity Volume <br /> t <br /> 1 - V7 <br /> .4 q <br /> Sample appearance Lock 1 <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> q" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks <br /> i Signature <br /> �I <br /> ;i <br />