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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> . C lent _�, /Q.4 fl S _, Sampling Date <br /> i Site 2/e s/ ¢ ��a 1���_ Project No <br /> SD Well Designation n�J V✓ d <br /> Is scrip of traffic control dev.ces required9 D YES time hours <br /> Is there stanetng water in the well box? YES Above I OC Below TOC <br /> Is top of casing cut level? NDy If no,sec remarks <br /> Is well cap sealed and lockedl NO If no,see remarks <br /> Height of well casing nsor(m inches) <br /> Well cover type 8"or 12" LV 12"2MCO X, 8"or 12"BK 8" Christy <br /> 12" Christy 8"M&D 12"M&D 12"DWP <br /> 12"GNI 36"CNI 12"Ponwo odwr <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_Z,_ Teflon bailer_ Disposable Tubing <br /> Well Diameter 2" X, 4" 6" 8" <br /> i Purge Vol Multiplier 016 065 147 2 61 gaVft <br /> i Initial Measurement Rechar a Measurement <br /> Time Time. _ Calculated purge <br /> Depth of well q' Depth to water o Actual purge <br /> Depth to water 7 <br /> Sta_-t purge 9 9 : 3 & Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> • t • 4 -7 <br /> f <br /> l <br /> Sample appearance Lock Al <br /> Al <br /> Equipment replaced (check all that applyf Note condition of replaced items) <br /> 2" Lccktng Cap Loch' "7lAllenhead <br /> C41- <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhedd(DWP) <br /> i <br /> i T <br /> i Remarks <br /> E <br /> i <br /> Signature <br /> g •d OOZE 13I'N3SLI1 dH Wdoi, 6 0002 60 hdW <br />