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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> { <br /> Client Sampling Date <br /> rSite Project No <br /> s �'�� ��,�-•^a-� Well Designation /tel r <br /> a <br /> f, <br /> Is serup of Traffic control devices requiredl YES time hours <br /> i <br /> Is there sanding water in the well boxyqN..D YES Above TOC Below TOC <br /> 1s ioo of casing cut Jevel9 _ Ifno, see remarks <br /> is well cap sealed and locked') NO � If no, see remarks <br /> Heigh, of well casing riser(in inches) <br /> well cover rype 8" or 12" UV 12"EMCO 8" or 12" BIS 8" Christy <br /> 12 Christy 8" M&D 12"M&D12"DW? <br /> [2 CN'1 36" CNI 12" Pomec-�X­ Other <br /> General condition of wellhead assembly Excellent Good` Fair Poor <br /> Purling Equipment2" disposable bailer - �—Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PV� bailer Centnfugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" _ — 6" 8" <br /> Purge Vol Multiplier 0 26 065 1 47 2 61 gal/ft <br /> Lniiial Measurement Recharge Measurement <br /> t� <br /> Time [ Time ( � Calculated purge 3� <br /> Depth of well �� Depth to water _SD (5,2— Actual purge 36- <br /> Depth io water <br /> l <br /> Start purge 5 Sampling time r< - 6 <br /> Time Tem erature E C H Turbidity Volume <br /> Z 6S I l 7 , 2 <br /> (� <br /> f <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-Dolphin9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) - <br /> Remarks <br /> Signature <br />