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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client r `e- Sampling DateC3_-> <br /> Site `e o h Project No <br /> Well Designation <br /> -tea CIAL 7-0 Al G. - <br /> Is setup of traffic control devices required? �O S tune hours <br /> Is there standing water in the well box9 - NO 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) Cr <br /> Well cover type 8"or 12"UV 12"EMCO 8" or 12"BK 8"Christy <br /> 12"Christy 8"MceGD 12"M&D I2"DWP <br /> 12"CM 36"CNI 12"Porneco Other <br /> General condition of wellhead assembly Excellent GoodFair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer� Teflon bailer Disposable Tubing <br /> Well Diameter 2" �� 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time Calculated purge ,, <br /> Depth of well q Depth to water i o,C> Actual purge <br /> Depth to water77 <br /> Start purge Sampling time a;22,,, <br /> Time Temperature E C pH Turbidi Volume <br /> �-- <br /> 3 <br /> Sample appearance, Lock <br /> Equipment replaced (check Al that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) <br /> �emarks <br /> Signature <br />