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r <br /> DOULOS ENVIRONMENTAL$INC. SAMPLING INFORMATIION SHEET <br /> Client Sampling Date <br /> Site /e C c Project No <br /> 57 16�we'0090, rJ 5 7, Well Designation Vw — <br /> �5�7pGK �r <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water to the well box? YES Above TOC Below TOC <br /> Is top of casing cut leveh NO lino,see remarks <br /> Is well cap sealed and lockedf NO If no,see remarks <br /> Height of well casing neer(m inches) <br /> Well cover type S"or 12"UV 12"EMCO 8"or 12" BK 8"Chnsty <br /> 12"Christy B"M&D 12" M&D 12"DWP <br /> 12"C I 36"CNI 1.2"Pomeco Other � <br /> General condition of wellhead assembly Excellent Gbod Fair Poor <br /> Purging Equipment- 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer C Centrifugal pump <br /> Sampled with Disposable bailer - Teflon bailer Disposable Tubing__ <br /> Well Diameter 2" �a 4" 6" S" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gallft <br /> Irutial Measurement Recharge Measurement <br /> Time = Tune Xf: 0 e> Calculated purge <br /> Depth of well r Depth to water 51 6 7 Actual purge <br /> Depth to water O <br /> Start purge Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> 1 7 <br /> s - � <br /> Sample appearance �,.-�° Lock <br /> Equipment replaced (check all that appyNote condition of replaced item(s) <br /> 2"Locking Cap LAcI .` •`" A]lenhead <br /> 4"Locking Cap Lock Dolphin + 9/16 Bolt <br /> 6"Lacking Cap Pinned Allenhead (DWP) <br /> Remarks f <br /> ' I <br /> Signature <br /> Z1< •d <br /> 0006 13C213Sk11 dH Wdbfr :G 000 60 AdW <br />