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!- "'" _ . .,, w+.`s,s,o-W+w...,,. ^-'we.nle.W[ +�4P�'lra+e•yK.yrF^.o+sn„r�'zCa. T. <br /> DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMApTION SHEET <br /> Client � ,� fr1 .s Sampling Date <br /> Site ;Rzay /ev <br /> � Project No <br /> Leo �M ���ra.r Well Designation <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water to the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked9 5- NO If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or l2"RK 8"Chnsty <br /> 12"Christy 8"M&6� 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2"disposable bailer e ^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 gal/ft <br /> 1rutial Measurement Recharge Measurement .8 Y <br /> Time o Time ; / Calculated purge ` <br /> Depth of well O rl - Depth to water Actual purge JS <br /> Depth to water - 1 <br /> Start purge I Q Sampling time 7 . 4 <br /> Time Temperature E C 2H Turbidity Volume <br /> 7L 9 7 <br /> s <br /> Sample appearance r� .�, Lock- <br /> Equipment replaced (check all that apply}l" Note condition of replaced item(s) <br /> 2" Locking Cap .Local ` , Allenhead <br /> 4"Locking Cap, Lkek-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DViP) <br /> Remarks <br /> Signature <br /> OT 'd OOZE 13C213SUI dH WdEb :6 0002 60 AUW <br />