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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> ' <br /> C'i — <br /> ent ��1P.4 ��l S Sampling Date <br /> Site Project No <br /> 2.zz:2 S-Vr�fa•,o,ti ,S 7L7 Well Designation1W <br /> e1XX111 t' <br /> Is senrp of traffic control devices required? YES tune hours <br /> Is there standing water in the well box? YE Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCD 8"or 12"BK 8"Christy <br /> 12" Christy B"M&D 12"M&D - <br /> 12"DWP <br /> 12"CNI 36"CNI 12"Porneca Other <br /> General conaition 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 X Centrifugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier a l6 065 147 2 61 gaVft <br /> lrutial Measurement Recharge Measurement <br /> Time ' 3 TimeLj Calculated purge f <br /> Depth of well 7- L Depth to water - SO Actual purge0i <br /> �t / <br /> R Depth to water <br /> s <br /> Start purge S: Sampling time w ; 17- <br /> Time <br /> 1Time Tern erature E C pH Turbidity Volume <br /> '�" '-/ ! 6 - 5, <br /> Lf <br /> 46 05' 19 <br /> # - / 6 6• <br /> 1 <br /> r <br /> i <br /> Sample appearance Lock 74 <br /> Equipment replaced (check a'_1 that apply)` Note condition of replaced item(s) <br /> 2" Locking Cap Loci{'—. ":7/4Allenhead' <br /> 4" Lacking Cap Lock-Dolphin it 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead(DWP) <br /> 0 Remarks 1 <br /> 1 <br /> Signature <br /> 3 <br /> E -d OOaC 13rN3Sd3 dH Wd0ir :6 000a 60 AUW <br />