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DOULOS nMIRONKENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_( i'r' ,&o::6 ,. ,r• Sampling Date: <br /> Site:�� �ty Project No. : q <br /> 1,- - Well Designation:_ L✓ -� <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y S 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) : "Iti _ <br /> Well cover type: S" W 12" UV12" EMCO $ ' BK <br /> 12" BK 1211 DWP 12" CNI 3611 CNI Other2A ' y- _'5 a X <br /> General condition of wellhead assembly: Excellent 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: Disposal bailer: Teflon bailer: <br /> well Diameter: 2" 4" 6" " ` 8" <br /> Purge Vol. Multiplier: 0.16 0. 65 1.47 2.61 gal/ft, <br /> —Initial Measurement Recharcre Measurement <br /> ime: ' Time:- 0 Calculated purge:l . OL <br /> Depth of well: ¢ b Depth to water: Z b Actual purge: a � <br /> Depth to water: <br /> Start purge: �2- �� z Sampling time: � � b <br /> Time Temp. E.C. pH Turbidity Volume <br /> 77 9 5 <br /> 6q9 9 , q -Z IC-D <br /> Sample appearance: Lock: <br /> Equipment replaced: (Checkallthat apply) Note condition of replaced item -- <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Is Remarks: <br /> signature: <br />