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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: jge-ot � 6$� Project No. :114 V <br /> ,...,,_ �. well Designation: MW-IS <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) ; _ J_4* 1 <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI other-U+k A_;/'AA <br /> General condition of wellhead assembly: Excellent 2d-04 Fair Poor <br /> Purging Equipment: a 2" isposable 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" 611_ 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> ime: Cl V Time: qDb Calculated purge: 2- 0#-41 <br /> Depth of well:. Depth to water: 2 1 Actual purge:1— <br /> Depth to water: C&09 <br /> Start purge: G50 Sampling time:_102 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6 q. y 1017 7 u-J -� l <br /> i <br /> Sample appearance: Lock: d_ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned, Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />