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DOULOS ENVIRONMENTAL COKPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: -7 <br /> Site: Project No. : - �9 <br /> L Well Des' <br /> i ignatien. M W 3 JL <br /> G <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Is Y 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 cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other /1' <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 Centrifugal pump <br /> Sampled with: Disposal bailer:1-- Teflon bailer: <br /> Well Diameter: 2" 4" 61t Sol <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2.61 gal/ft. <br /> Initial Measurement -Rech ar. a Measurement <br /> �ime: I Time: d Calculated purge: l -71 <br /> epth of well: Depth to water: u'^S� 4 Actual purge: a <br /> Depth to water: 4 S� <br /> Start purge: 1 3 Sampling time: Z� <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 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> 40 Remarks: <br /> Signature: <br />