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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> Site ^ <br /> Project No <br /> Well Designation W — <br /> is scrap of traffic control devices required? � YES ti <br /> k there standing water in the well boxy rne hours <br /> is top of casing cut lever No YES AAbove TOC $e1owTOC <br /> 1y kvelt cao sealed and locked If no, see remarks <br /> NO If no, see remarks <br /> Height of well casing riser (tn inches) <br /> 1+'e13 cover rype 8' or 12" UV 12"EMCO 8" or 12"BK <br /> 8" Christy <br /> 12 Chrtsry 8" M&D 12"M&D 12"DWP <br /> i 2 CN1 36" CNI 12" Porncco Other <br /> General condition of wellhead assembly Excellent Good Fau Poor <br /> Purging Equipment 2" disposable bailer �Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" Py bailer Centnfugal pump <br /> Sampled with Disposable bailer .r Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" g„ <br /> Purge Vol Multiplier 0 16 7 65 1 47 _2_6—1 gal/ft <br /> lninal Measurement <br /> Recharge Measurement <br /> • Time O Time Calculated purge 7 <br /> Depth of well Depth to water ,�� Oe Actual purge <br /> Depth to water 0 <br /> Start purge LU Sampling time, <br /> Time Tera erature E C pH Turbidit Volume <br /> o i&l,- '7 - l7 '� l 7 z 3 <br /> 1 %o r7 - / 7Ja 2� <br /> 173 '-3 0 3 <br /> Sample appearance C —_11wz-- Lock _/1-11 <br /> Equipment replaced (check a]] that apply) Note conattion 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 Allen-head (DWP) <br /> Remarks <br /> JI`T1a[L?r2 <br />