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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> a <br /> Client: Sampling Date: <br /> Site: 6 Project No. : <br /> Well Designation: W�3 <br /> V <br /> Is setup of traffic control devices required? YES time: hours <br /> . Is there standing water in well box? Above TO ow TO <br /> Is top of casing cut level? Nr If no, seer s <br /> Is well cap sealed and locked? NOIf no, see remarks <br /> Height of well casing riser (in inches) : tX *16 <br /> 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 /> - III ..I I ..III�IIIALI`Lll�rla.gq Ilp..�l� <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _ cCentrifugal pump <br /> Sampled with: Disposal bailer- Teflon bailer: <br /> Well Diameter: 2" 4"29v- 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> ime: 506 Time: Calculated purge _ <br /> epth of well: 51 Depth to water:.k�f�.s7Actual purge: <br /> Depth to water. 4d 7 <br /> Start purge:. .., 3 5 Sampling time: SSS <br /> Time Temp. E. C. pH Turbidity Volume <br /> 115.1 1.62 2, <br /> 1f3.V1 ) e---- <br /> b1 016tJ <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: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: t. <br />