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a� <br /> s DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client � � ` Sampling DateSite <br /> 0 <br /> ��...� Project Na <br /> Well Designation <br /> A LL- <br /> Sew <br /> 1 of traffic control devices required O YES time hours <br /> fs there standing water in the well boxy <br /> YES Above TOC Below TOC <br /> Is top of casing cut levels O If no,sec remarks <br /> is well cap seaied and locked NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> I co%er type 8' or 12" UV 12"EMCO 8" or 12"BK 8"Christy <br /> 2 Chrisry 8" M&D 12"M&D _ 12"DWP <br /> t 2 C'N11 36" CNI 12"Pomcco Other <br /> General condition of wellhead assernbly Excellent Good 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 bailerP Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" g" <br /> Pure Vol Multiplier <br /> gQ 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time /c:�) r 2 Time 2 ' D Calculated purge <br /> t Depth of wells Depth to water <br /> P 0' Actual purge �f <br /> ll Depth to water <br /> li <br /> u Start purge _ j ' S� Sampling time t' 2 <br /> 1 Time Tem erature E C H Turbidit Volume <br /> S � l o � <br /> Sample appearance -� e . L Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> ^" Locking Cap Lock Dolphin 9/l 6 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> *Remarks <br /> Signaiure <br />