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•DOULOS ENVIRONMEIiITAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: _� Sampling Date: <br /> Site: _ Project No. : "'I Lkam te <br /> ~ Well Designation: <br /> Is setup of traffic control' degices required? YES time: hours <br /> Is there standingwater' we <br /> . in� ll box? Above TOC Below TOC <br /> Is top of casing cut7evel? ' x " ` NO If no, see remarks <br /> Is well cap sealed"'arid locked? - : NO E If no, see remarks <br /> Height of wellI : <br /> inches) : <br /> Well Cover type <br /> '=h'Y�`- 22" 'UV 12" EMCO 8" BK <br /> 12" BIS 12 DWP 12" CNI 36" CNI Other <br /> General conditior "of wellhead"assembly: Excellent Good Fair Poor <br /> Purging Equipment:` ;.,-` ""....Y- 2._, .disposable bailer submersible pump <br /> war = 2'! .PVC bailer Dedicated bailer <br /> ` 4n -PVC bailer Centrifugal pump <br /> Sampled with:. " Disposal bailer: Teflon bailer: <br /> Well Diameter:- 2" 4 TT 61T 8 TT <br /> Purge Vola Multipliers D'.16+ .r. 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement',- _- ,.. Recharge Measurement <br /> Time: Z 5'1- `°'"' `- Time: Calculated purge: <br /> Depth of well: 40)x _ "'= Depth to water: Actual purge: <br /> Depth to water:_ Ltn ,2 i_ <br /> Start purged = '� . Sampling time: <br /> - -5. <br /> Time Temp:,: _F'. E.C. pH Turbidity Volume <br /> . .- -. - .. fir=.;�4l;?s•°. .c5„ <br /> Sample appearance: �,r:Y�F ,r.t�- 1 `�, <br /> Lock: <br /> Equipment. replaced.,:,--,.-,. ,(Check all-that- apply) Note condition of replaced item <br /> 2" Locking Cap: R'P - = = 1;ock #3753: 7/32 Allenhead: <br /> 4" Locking Cap: :: T=:= 'Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: : `.4 ,- Pinned Allenhead (DWP) <br /> ]Remarks:-" -- k <br /> v.- <br /> .•ans 7d -.r <br /> ... + :.;. •.• i .nom ri _ �:� �.a . <br /> - <br /> ! M <br />