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a <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date —Q <br /> Site - Protect No <br /> Well Designation 11L-J <br /> !s secui) of traffic control devices required9O YES <br /> Is ihere standing water in the well box9 time - hours <br /> NO <br /> 15 cop of casing cut ievcl� Above TOC Below TOC <br /> NO <br /> Is %yell cap sealed and locked If no, see remarks <br /> He-& of well casing riser (in inches) NO If no, see remarks <br /> welChroSer type 8" or 12" UV 12 EMCO 8"or 12" BK <br /> 12 Christy <br /> 12 C�'I ry36' CN&D� 12" M&D 12" DWP <br /> 12" Pomeco Other <br /> General cond-itton of wellhead assembly Excellent Good <br /> Fau' Poor <br /> Purging Equipment 2" disposable bailer <br /> Submersible pump <br /> _2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfuga! pump <br /> Sampled with Disposable bailer �� Teflon bailer <br /> Dz osable Tubing <br /> Well Diameter 2" „( 4>' 6 <br /> " $>, <br /> Purge Vol Multiplier 16 0 65 ---- <br /> fmoal Mcasurement Rech1 47 2 6 i gal/�t <br /> ar e Measurement <br /> Time <br /> Time _� 41 f Calculated ur <br /> Dcnlh o�well Depth to water a A gr <br /> Depth �o water <br /> p Actual purge <br /> Siam purge Sampling time <br /> Time Tem erasure E C off Turbidtt <br /> Volume <br /> 7 <br /> 9 <br /> Sample appearance Lock <br /> EQuinment replaced (check all that apply) Note condition of replaced iterr(s) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> Locking Cao Lock-Dolphin9/16 Polt <br /> cck ng Can >' Mea Allenheac (DWP) <br /> 5 ",sure <br />