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. SAMPLING INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL COMPANY <br /> Client: Lt Sampling Date: ��-� — <br /> F Project No. : <br /> Site• 6 R&ea-�'°" <br /> 40 2UL-t 1,,Well Designation:,�lW��3 <br /> Is setup of traffic control devicesrequired? � y= time- hours <br /> Below TOC <br /> Is there standing water in well box'. YES <br /> Is top of casing cut level? NO � If a see remarks <br /> If no, see remarks <br /> Is well cap sealed and locked? N <br /> Height of well casing riser (in inches) 12n EMCO g11 BK <br /> Well cover type: 8" UV <br /> 12 Of BK 12" DWP 12" CNI36" CNI her, `�•,� <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 21' disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer: _ Teflon bailer: <br /> 811 <br /> Well Diameter: 2" 4" 6" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 ,61 gal/ft. <br /> AMIkTnitial Measurement Recharge Measurement <br /> Time; Calculated purger <br /> ime: Depth to water: 07 Actual purge: id,V_ <br /> Depth of well: <br /> Depth to water: <br /> Start purge: 600 Sampling time:_K2-0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6 O � 2 <br /> 6 d ��21Y l 3 07 <br /> J <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item - - <br /> 21, <br /> tem _ _21, Locking Cap:� Lock 13753 : 7/32 A l lenhead: <br /> 4" Locking Cap• _ Lock-Dolphin:_ 9/16 Bolt: <br /> 6" Locking Cap: — Pinned A1lenhead (DWP) ; <br /> Remarks: <br /> Signature: <br />