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DOULOS )ENVIRONMENTAL,INC. SAMPLING INFORMA'T'ION SHEET <br /> C lent Sampling Date <br /> Site &Q .2/ <«_'-4-� prodectNo <br /> i 2-=e.2-S]2 Well Designation <br /> t <br /> Is setup of traffic control dev,ces required? YES tune hours <br /> Is there standtmg water in the well box? W YES Above TOC Below TOC <br /> Is top of casing cut kve17 NO d If tio,see remarks <br /> is well cap sealed and locked? NO If no, see remarks <br /> Height of xell casing naer(in unches) <br /> Well cw,er Type 8"or 12" UV 12"EMCO_X, 8"or 12"BK 8" Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12" CNI 36" CNI 12"Pomeco Other <br /> General conainon of wellhead assembly Excellent - Good_�C_ 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 16 065 147 2 61 gal/ft <br /> irutial Measurement Rechame Measurement <br /> Time ' �' Time Calculated purge 7` <br /> Depth of well Depth to water Actual purge <br /> Depth to water <br /> Start purge _ 0 :_ 0 Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> 10 z", tl <br /> f <br /> S <br /> t <br /> f <br /> Sample appearanceLock <br /> Equipment replaced (check all that applyf Note condition of replaced item(s) <br /> 2" Locking Cap Locx� '4W4&Allenhead <br /> 4"Locking Cap Lock-Dolphin 9116 Bolt- <br /> 6" Locking Cap Pinned Alleiihead(DWP) <br /> t <br /> Remarks <br /> Signature <br /> � •d OOZE 13rd3SUI dH Wd0ip =6 0002 So AUW <br />