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�r M <br /> r-, - t ta-r Yr,NMY 1v'lT�T}h•Twr'...1 <br /> DOULOS ENVIRO_'YMENTAL,INC. SAMPLING INFORMATION SHEET <br /> clientJ 7�Ip� (J .S' Sampling Date r� <br /> Site le .sr Project No <br /> a S 7 Well Designation �/ e <br /> r� <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water in the well box9YES Above TOC Below TOC <br /> Is top of casing cut lever If no,see retnaiks <br /> Is well cap sealed and locked9 NO If no,see remarks <br /> Height of we 1 casing riser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8" Christy <br /> 12' Chnsry8"M&D 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Porneca Other <br /> General condition of wellhead assembly Excellent Good— Fair Poor <br /> Purging Equipment 2"disposable bawler 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 016 065 147 2 61 gallft <br /> Initial Measurement )charge Measurement 7 <br /> Time = 0 3 Time, � .' Calculated purge <br /> Depth of well �• q l Depth to water 1��` !�� Actual purge <br /> Depth to water • 7 <br /> Start purge .28 Sampling time �p - <br /> Time Temperature EC pH Turbidity Volume <br /> s , <br /> ( 00 <br /> 3 <br /> Sample appearance �c.�leLockt <br /> Equipment replaced (check all that apply}' Note condition of replaced item(s) <br /> 2" Lock.ng Cap Loch" `071 Allenhead <br /> 4" Locking Cap Lock-Dolphm �` 9116 Bolt <br /> 6" Locking Cap' Pinned Allenhead(DWP) <br /> Remarks <br /> Signature <br /> gj d 002E 13rd3SH`1 dH Wdbla =6 0002 Go AUW <br />