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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client // Sampling Date <br /> Site /•e << s Project No <br /> ` 2=z52 EDo .5 7�: Well Designation v 6✓ <br /> f <br /> 1s setup of traffic control devices required? 039 YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TQC <br /> i is top of casing cut lever O If no,see remarks <br /> t Is well cap sealed and locked NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12">;JV 12"EMCO 8"or 12"BK 8" Christy <br /> 12" Christy 8" M&D 12"M&D 12"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 Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 81) <br /> Purge Vol Multiplier 016 065 147 2 61 gallft <br /> Initial Measurement Recharge Measurement <br /> Time / Time /d 3 Calculated purge 3 <br /> i Depth of well Y Depth to water � 7 O Actual purge <br /> Depth to water 5 6 <br /> i <br /> Start purge /o = 17 Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> lo - O 6a -�- OBD <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply}`'• Note condition of replaced item(s) <br /> 2" Locking Cap Loch' "l/ Allenhead <br /> 4" Locking Cap Lock-Dolphin i4 9/16 Bolt <br /> 6" Locking Cap Pinned Al ennead (DWP) <br /> ..emarks <br /> Signature <br /> �t� <br />