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r <br /> DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client iP.4 tiU s_ _ _ Samphrig Date R- 17-0-q <br /> f <br /> Site f << r Prol ect No <br /> S� rprrl _ 7�% Well Designation 7 <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water an the well boxy Above TOC Below TOC <br /> Is tap of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked9 NO If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"W 12"EMC4_. 8"or 12"BK S"Christy <br /> ­ <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fa u 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 616— 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement 43Time k<r Time � f Calculated purge <br /> Depth of well 0 Depth to water _ �.° �� Actual purge <br /> Depth to water • 1 <br /> Start purge -7 ' AO Sampling time 7 = <br /> Time Temperature E C pH Turbidi Volume <br /> N <br /> Sample appearance Lock, � �- <br /> Equipment replaced (check all that appy''` Note condition of replaced item(s) <br /> 2" Locking Cap' Loch.' . "'f4Allenhead <br /> 4" Locking Cap Lock-Dolphin-, '4 7 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead(DWP) <br /> Remarks <br /> Signature <br /> f� <br /> 9 d OOOE 13rd3Sd-1 dH WdTbi6 00130 s0 AdW <br />