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t <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client .znll. Sampling Date <br /> Site acneL4 Jz" Project No <br /> 5 <br /> 2-,060 ,9Designation M LA- <br /> Well <br /> 1 <br /> k >emp of rraffic control devices required) YES time hours <br /> IS there standing water in the well box9 YES Above TOC Below TOC <br /> k top of casing cut ]ever NO If no, see remarks <br /> is +%ell cap sealed and locked') NO If no, see remarks <br /> 1-1ctghi of well casing riser (in inches) <br /> 1, X11 cover type 8" or 12" UV 12" EMCO 8"or 12" BK 8" Christy <br /> 12 Chrisry 8" M&D 12"M&D 12"DWP <br /> 12 ' CNI 36"CNI 12"PoinecOther <br /> General condition of wellhead assembly Excellent 77 11 Good_ Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC 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 0 65 1 47 2 61 gal/ft <br /> lriiial Measurement Recharize Measurement <br /> Time &1' `-{ V Time Calculated purge S • C) <br /> Depth of well q Depth to water F7. Actual purge c <br /> Depih co water <br /> Scant purge U130 Sampling time <br /> Time-1 Temperature EC pH Turbidity Volume <br /> to . n 1 <br /> o 6 • � � <br /> I <br /> Sample appearance �o1_�_ Lock <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 /> Signature <br />