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DOULOS ENVIRONMEN'T'AL COMPANY SAMPLING INFORMATION SHEET <br /> Client : 1 C o Sampling Date• 2 7 -nom <br /> le Site :- 91 b _ T_ Project No . : <br /> /1/. C41r fO N/fi Well Designation: IV) <br /> W <br /> oc oe:!� C /1 , <br /> Is setup of traffic control devices required YES time: hours <br /> Is there standing water in well box? � YES Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked? No E If no, see remarks <br /> Height of well casing riser (in inches) - _ :: - y _ <br /> Well cover type : 8" UV 1,2" UV 12" EMCO 8" BK <br /> 12 " BK 121' DWP 12" CNI 36" CNI —Ether 12 / /J <br /> General condition of wellhead assembly: Excellent (-Co 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: <br /> Well Diameter: 2" 4"_X' 6" 811 <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Bechar e Measurement 0 <br /> Time ` 1U Time: Calculated purge: <br /> Depth of well . 7 6 y Depth to water: '4 --7 K�; Actual purge SQ <br /> Depth to water; Yf 19, <br /> Start purge: Sampling time:. ? <br /> Time Temp. E. C. pH Turbidity Volume <br /> � �_� g I l -_�; 8o -7 f� <br /> h '_ Y -T2 0 1 /3 Lf / 7. d �-- <br /> = S2 2 � / 1300 7 ©� �— <br /> Sample appearance- Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4 " Locking Cap: Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) , <br /> Remarks : <br /> Signature <br />