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1 <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> iSite _ �.�� �,,, e-','�Ze24 Project No <br /> Well Designation <br /> n <br /> s c � <br /> Is setup of rrafftc control devices required9 YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut levels CFO If no, see remarks <br /> Is welt cap scaled and locked NO If no, see remarks <br /> Heignt of well casing riser(in inches) S <br /> Well cover rype 8" or 12" LW 12" EMCO 8" or 12" BK 8"Christy <br /> 12 Chrisry 8" M&D 12"M&D 12"DWP <br /> 12 ' CN1 36" CNI 12" Pomeco Other <br /> General condmon of wellhead assembly Excellent Goode 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 bailer Teflon bailer Disposable Tubing - <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 I6 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time /0 ' /9 Time �� _ 0 e Calculated purge <br /> Depth of well ' C7_� Depth to water f0 / Actual purge <br /> Depth to water F 7 a <br /> Start purgeI Z�s Sampling time n <br /> Time Tem erature E C pH Turbidity Volume <br /> 6 - y <br /> Sample appearance Lock j9(v_f —�-� <br /> Equipment replaced (check all that apply) Note condition ofreplaced ,tem(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />