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i <br /> S � <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> a <br /> ClientS=&2 Sampling Date <br /> Site Project No ' <br /> LD Wel] Designation /t"\ w —4' <br /> Ica A <br /> r <br /> Is senip of traffic control devices required YES time hours <br /> is there sEanding water in the well box? 65 YES Above TOC Below TOC <br /> Is :op of casing cut lever NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> rieighi of well casing riser(m inches) <br /> Will cover type 8" or l2"UV 12" MCO 8" or 12"BK 8"Christy <br /> '2 Chrisry 8" M&D 12"M&D 12" DWP <br /> 12 'CNIl 36" CNI 12"Pomeeo Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfuga] pump <br /> Sampled with Disposable bailer . .5 Teflon bailer Disposable Tubing <br /> Well Diameter 2" r\ 4" 6" g" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> �. Time CO' 2a Time ]a (� Calculated purge <br /> Depth of well _ ��` E4 Depth to water Actual purge <br /> Depth to water <br /> I <br /> ' Start purge 2 : Sampling time y 2 <br /> Time Temperature E C H TurbidityVolume <br /> I <br /> 1 <br /> 7- 3 Z, <br /> Sample appearance - _ Lock D <br /> Prippment renlarPd (r},PC]t all tkn appy) Note condition of replaced itern(s) . <br /> 2" Locking Cap Lock: 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DW?) <br /> . Remarks <br /> Signature <br />