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DOULOS ENVIRONMENTAL,, INC SAMPLING INFORMATION SHEET <br /> Client _ Sampling Date <br /> iSite Gt.Qiidr .jam`, Project No <br /> L� Well Designation //l `- <br /> LA <br /> k setup of rraffic control devices required YES time hours <br /> Is 'here standing water to the well box? YU Above TOC Below TOC <br /> is top of casing cut lever wo dw If no, see remarks <br /> is %%ell cap sealed and locked? NO S If no, see remarks <br /> Hcivht of well casing riser(in inches) <br /> \, ell coyer type 8" or 12" UV 12" EMCO 8" or 12" BK 8" Christy <br /> 2 Chrtsry 8 ' M&D� 12" M&D 12"DWP <br /> 12 CNI 36" CNI 12" Pomeco Other <br /> Ceneral condition of wellhead assembly Excellent Good—XI- Feer 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 0(i P Teflon bailer Disposable Tubing <br /> Well Diameter 2"Y X 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gat/ft <br /> LnivaI Measurement Recharge Measurement <br /> r <br /> Time G =3 O Time -7 : O Calculated purge d , <br /> Depth of well f O q • Depth to water �,30 Actual purge ----3�0--_ <br /> Depth to water <br /> purge <br /> Start = Sampling time / D <br /> Time Tem erature E C pH Turbidity Volume <br /> Sample appearanceLock <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 f <br /> signature <br />