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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> l <br /> Client Sampling Date ��� <br /> /[ site Project No <br /> 3' LO Well Designation /►/1 �- <br /> 5 <br /> ' k setup of rraffic control devices required9 YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is iop or casing cut lever 0 If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> neigh, of well casing riser(in inches) <br /> Nell coNIer type 8" or 12"LN 12" EMCO 8" or 12"BK 8"Christy <br /> 12 Christy 8" M&D 12"M&D 12" DWP <br /> 12 CNI 36" CNI 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Goodc Fair Poor <br /> Purging Equipment 2" disposable bailer -- —Submers)b)e pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tub[ng_2:�i_ T <br /> Well Diameter 2" 4" 6" g°° <br /> Purge Vol Multiplier 0 16 0 65 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> j . Time Ic ' Time 1 © DCalculated purge 2- <br /> Depth of well _ j 4 q D Depth to water _ 3�6 - 6�- Actual purge _ 7 <br /> Depth to water Li _ ( 3 <br /> Start purge Sampling time 0 <br /> Time Temperature EC pH TurbiditX Volume <br /> b 1 / 362 L <br /> 2- <br /> Sample appearance ��'�-� ear..ti Lock �t <br /> Equipment replaced (check all that appl-y`) Note condition of repiacea ttemts) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> I* Remarks <br /> $i TMt2[ure <br />