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r <br /> DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> Site � �� t Project No <br /> lz:� 5 _ �e"-ioe/f-5 f`; Well Designation /`ek <br /> Is setup of traffic control devices required? YES force hours <br /> 7s there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level's o If no,see remarks <br /> Is well cap scaled and locked" NO If no,see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8" or 12"W 12"EMCOr 12"BK8"Chnsty <br /> 12" Chnsry 8"M&D 12"M&D 2'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 _ Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer—sf--= Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 1 065 147 2 61 gal/ft <br /> Initial Measurement Rechanze Measurement <br /> Time = Tune Calculated purge __ <br /> Depth of well 4 - Depth to water Actual purge R <br /> Depth to water 0 <br /> 3.5 <br /> Start purge 7 = Sampling time Z <br /> Time Temperature E C i H I'urbidr Volume <br /> �� �� -714 7 ` V ( <br /> p <br /> Sample appearance �� Lock <br /> Equipment replaced (check all that apply''' Note condition of replaced itern(s) <br /> 2" Locking Cap Lock' I " Allenheati <br /> 4"Locking Cap Lock-Dolphin 4T 9116 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br /> g -d OOZE 13C63Stt3 dH Wddi, =6 0002 60 AUW <br />