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DOULOS ENVIRONMENTAL COMPANY SAMENUf INFORMATION SHEET <br /> • Client: Sampling Date:__9- 36 '00 <br /> Site ProDect No. : 1' � <br /> Well Designation:, vV �3_ <br /> Is setup of traffic control devices required? O YES time : hours <br /> Is there standing water in well box? YES 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 riser (.in inches) - <br /> Well <br /> nches) •Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12 " BK 12" DWP�_ 12" CNI 36" CNI Other <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 bailerCentrifugalpump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4"-Z — 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1 . 47 2 . 61 gal/ft . <br /> ,Init ' al Measurement Recharge Measurement <br /> Time . I ' Time: Calculated purge . G. _L <br /> Depth of well . f3AS Depth to water: -L / 3Actual purge. C>6,-'- ,,j <br /> Depth to water : <br /> Start purge : I S Sampling time: 1 7 r�,D <br /> Time Temp. E.C. pH Turbidity Volume <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 /> f <br /> Signature , /� <br />