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F <br /> 1 <br /> r, DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Y q <br /> y ClientSzzn Sampling Date <br /> Site Project No <br /> a LO /f--r,��.,�,�,,, �� Wel] Designation M <br /> a <br /> I> >eru <br /> p of traffic control devices required YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> t k top of casing cut level9 NO ja� If no, see remarks <br /> Is ��ell cap sealed and locked? 5 NO E If no, see remarks <br /> Height of well casing riser(in inches) <br /> 1k ell co%er type 8" or l2" UV 12" EMCO 8"or 12"BK 8" Christy <br /> 1 2 Chrisry 8 'M&D 12" M&D 12"DWP <br /> 12 CNN 36" CNI 12"Pomec� Other <br /> General condition of wellhead assembly Excellent Good zaz <br /> 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 s P-- Teflon bailer Disposable Tubing <br /> .I v <br /> Well Diameter 2" ^ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time Calculated purge {� _ <br /> • Depth of well C O C7 • 0 y Depth to water Actual purge <br /> Depth to water <br /> Startur e 0 Sampling time 1 3 <br /> p g <br /> Time Temperature EC(/ �J7 H r� TurbidityVolume <br /> f ! V • V \ i l - ' V <br /> V <br /> y <br /> Sample appearance 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 /> Wemarks <br /> i <br /> a <br /> Q <br /> Signature <br />