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' r ' _ ^r,...r ,�,wrnr,.,.+n..nN.....�...«.v.r...er,r•-�,. #�'M^•'xwl+.rs>a.r a .sy,+- •r <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date 7-a <br /> l <br /> Site / c s` Project No <br /> _ Well Designation <br /> E �556o G k&—:KZ e-�. <br /> Is serup of traffic control devices required9 YES tune hours <br /> Is there standing water in the well box9 +� YES Above TQC Below TOC <br /> Is top of casuag cut level? NO � If no, see remarks <br /> Is well cap sealed and locked9 NO If no,see remarks <br /> Height of well casing user(ui inches) <br /> well cover tvpe 8"or 12"L-V l2" EMCO r 12"BK_ S"Christy <br /> 12" Christy8"M&D 12"M&D 12"DWP <br /> 12' CNI 36"CNI 12" Porneco Other <br /> General condtnon of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2"disposable bailer X Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 44"PP —bailer Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2"__,!K _ 4" 6" 8" <br /> i Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharize Measurement <br /> Time <' Time `W Calculated purge <br /> Depth of well O O Depth to water Actual purge Z A ' <br /> Depth to =eater <br /> €i <br /> i Start purge Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> ' t <br /> Sample appearance <br /> C- 'C� Lock AC <br /> &}uipment replaced (check all that apply)'' Note condition of replaced item(s) <br /> 2" Locking Cap LocK' *,'I/&Ali anhead <br /> 4"Locking Cap Lock-Dolphin T 9116 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> E <br /> I <br /> Signature <br /> �, •d 002E 13C836d1 dH WdTV :6 0002 6o AuW <br />