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±DOULOS ENVIRONMEN'T'AL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site +; 6 : {i � Project No. <br /> 1 Designation'. <br /> setupIs of traffic control'-devices required? O YES time: hours <br /> Is there standing#water in`,wellbox? YES Above TOC Below TOC <br /> Is top'' of casing cut4�avel'� NO If no, see remarks <br /> Is well ' cap seale-d� '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" SK 1211 %121!_ CNI 36" CNI Other Z y <br /> General condition of wellh'eadn"Assembly: Excellent Good Fair Poor <br /> Purging E - :.,�:_,:. <br /> quipment:-,- T 2�' disposable bailer Submersible pump <br /> 2'i,,,_PVC,bailer Dedicated bailer <br /> 4"` PVC bailer Centrifugal pump <br /> Sampled with:"-= Disposaf-bailer:A/ Teflon bailer: <br /> Well Diame. - <br /> ter: 2" 4" 6 8 <br /> Purge Vol.` Multiplier 0.'16 s _ 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial. Measurement Recharge Measurement <br /> Time: 2 - = ` `_ ' Timed 7" Calculated purge: 3. c� <br /> Depth of well• 'c"'' - <br /> P Depth to water: S31, L Actual purge:_ -! <br /> Depth to water: .12,r7 <br /> s ¢way <br /> Start purge: L�%f °i : Sampling time: <br /> Time Temp: pH Turbidity Volume <br /> 7, <br /> 7.7 <br /> Sample appearance,. -_ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap•• = ` `'`W''I;ock 13753 <br /> - -���:�.� 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin• 9/16 Bolt: <br /> 6" Locking Cap.: Pinned Allenhead (DWP) <br /> Remarks•` <br /> -L°ir�PS'AF <br /> =zr: <br />