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a — <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client he A U Ira � Sampling Date <br /> Site ` e ►1 Project No <br /> Well Designation <br /> �SS�a c�L 7�a " <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? YES 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 nser(in inches) <br /> Well cover type 8" or 12"W 12"EMCO 8"or 12"BK 8" Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other a <br /> General condition of wellhead assembly Excellent Good Fair 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 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharee Measurement <br /> Time �p Time /0'a5_— Calculated purge <br /> Depth of well 10 Depth to water Actual purge <br /> Depth to water <br /> S93- <br /> Start purge 10:M!� Sampling time � <br /> Time Temperature E C pH Turbidity__ Volume <br /> o ' 1 <br /> 100'' <br /> o< <� <br /> Sample appearance 04 // Y Lock <br /> 4 ILL <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />