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if , � ,.,,.v,-.wit• �y+l'++r+Www«rM+.-w+�.MHm,•F.,.M.wti.=.7�sMe..,nww�kl�w��N..i.e,Mrie.un.r Wi"!Ya'�vi <br /> r DOULOS ENVIRONMENTAL, INC, SAMPLING INFORMATION SHEET <br /> Client IY1 t l : — _ Sampling Date 9 7— <br /> Site � Project No <br /> Well Designation <br /> & 14 (kf. <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there stancing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no,sec remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of w ell casing user(in inches) <br /> well cover type 8"or 12"LV 12" hMCO 8"or 12"BK 8"Christy <br /> 12" Christy6"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CM 12"Porneco 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 Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gallft <br /> 's Initial Measurement Recharge Measumment <br /> t Time d Time O = ro Calculated purge " <br /> Depth of well IN IS Depth to water 5-A --10 Actual purge <br /> Depth to water <br /> Start purge '9 SarripIing time = <br /> Time Temperature EC pH Turbidity Volume <br /> X - 22 ,0 { �' <br /> 3 Q 9- <br /> Sam ple <br /> Sample appearance C_l & Lock <br /> Equipment replaced (check all that apply}' Note condition of replaced item(s) <br /> 2" Locking Cap Lor1R' `"'/ Allenhead _ <br /> 4" Locking Cap Lock-Dolphin _ - 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead(DWP) <br /> f <br /> Remarks --- <br /> I <br /> Signature <br /> t t •d 0026 19rd3SUI dH 14d6" :G ooaz so Adw <br />