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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Sampling Date: <br /> Site• 2 2-� Project No. :/-4 <br /> , ell Designation:, �&w yW`3 <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? NO 12D If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type 8" W 12" W 1.2" EMCO 8" BK <br /> 1.2 " BK 12" DWP 1.2" CNI 36" CNI Other I.X <br /> General condition of wellhead assembly. Excellent oo Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer r Centrifugal pump <br /> Sampled with Disposal bailer•_ Teflon bailer: <br /> Well Diameter• 2" 4" _ 6T' 8'T <br /> Purge Vol . Multiplier: 0 16 0 . 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time /635 Time: Calculated purge: IX <br /> ,I*epth of well . (j8.k3 Depth to water: Actual purge : l1.•Z. g <br /> epth to water. <br /> Start purge Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1 B"3 Z 2-1-r 2. 16 <br /> d <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: 9/1.6 Bolt <br /> 6" Locking Cap. Pinned Allenhead (DWP) : <br /> Remarks . <br /> ,0 <br /> Signature <br />