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i <br /> DOULOS ENVIRONMENTAL COMPANY SAMMObIft, INFORMATION SHEET <br /> • Client: Sampling Date: 4-36`00 <br /> Site • Project No. : <br /> Well Designation: <br /> Is setup of traffic control, devices required? N YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? qns If no, see remarks <br /> Is well cap sealed and locked NO <T If no, see remarks <br /> Height of well casing riser (in inches) : '3 _ <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12 " DWP 12" CNI 36" CNI her <br /> General condition of wellhead assembly. Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailer _Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer Centrifugal pump! <br /> Sampled with : Disposable bailer: Teflon bailer `s <br /> Well Diameter; 2"-4— 4" 6" 8" <br />. Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement echar a easurement <br /> Time :- /1} 3I Time: Calculated purge : �. <br /> Depth of well : / 16-co Depth to water: — / Actual purge : 6S �� <br /> Depth to water: z-i. M <br /> Start purge; 16 OF Sampling time: � <br /> Time Temp. E. C. pH Turbidity Volume <br /> 71, <br /> 16 /-619©, V_ 5� 711 �2' <br /> f b 20,-2 .-3 1 n s' <br /> Sample appearance: d�T 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 : , 37 <br /> /d <br /> Signature • <br />