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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client k' 51VUlr0 ,,,,, � _ Wil___ Sampling Date <br />�r Site -0 V� Project No <br /> Well Designation <br /> Is setup of traffic control devices required? N YES time hours <br /> Is there standing water m the well boxy YES Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(m inches) 77-0 <br /> Well cover type 8" or 12" W 12" EMCO 8"or 12"BK 8" Chnsty <br /> 12"Chnsty 8"M&D 7:' � 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fau 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—X— Teflon bailer Disposable Tubing <br /> .'.. <br /> Well Diameter 2" 4" 61 <br /> 1 <br /> 811 ._ <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Imt1al Measurement Rechar e Measurement <br /> Time Time Calculated purge <br /> Depth ofwell Depth to water Actual purge <br /> Depth to water <br /> Startpurge JO.Sa Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> Q20 <br /> r C) <br /> Q � , <br /> a <br /> c <br /> Sample appearance C:�Lou JrLock <br /> Equipment replaced (check all that apply) Note condition of replaced items) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> {•Remarks <br /> S i gnature <br /> f <br />