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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEAT <br /> Client Sampling Date `�p •Q <br /> Site F _ Project No <br /> Well Designation <br /> Is senlp of traffic control devices required? YES <br /> 1� ihere standing water to the well box9 time hours <br /> Is top of casing cut lever Above TOC Below TOC <br /> NO If no, sec remarks <br /> Is well cap scaled and locked? <br /> NO If no, see remarks <br /> Hey& of well casing riser(in inches) <br /> Well cover We 8" or 12" UV 12 EMCO <br /> 12 Chrzsry8" M&D $" or I2" BK 8" Christy <br /> 12 CN'l 12 M&I) l2" DWP <br /> 36 CNI 12" Pomeco Other �r�l, <br /> Central condition of wellhead assembly Excellent Good <br /> Fair Poor <br /> Purg-ng Equipment 2" disposable bailer <br /> Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer / Centnfugal pump <br /> Sampled with Disposable bailer z Teflon bailer <br /> — — _ — Disposable Tubing <br /> Well Diameter 2" _ 4„ 6„ <br /> 8„ <br /> Purge Vol Multiplier 0 16 7-6 7 47 <br /> Initial Measurement 2 6] gal/ft <br /> -. Rechar e Measurement <br /> m <br /> Tie Time 'i'/ <br /> Depth of wellx Calculated purge 3 <br /> Depth to water • *7 Actual purge , t> <br /> Depth to water I. �. <br /> Start purge ©0 Sampling time <br /> Time Tern erature E C H Turbidit <br /> 'Se 11 volume <br /> Sample appearance Lock yr , , ,✓ <br /> Equipment replaced (check all that apply) _ <br /> Ca pp Y) Note condition of replaced item(s) <br /> ?" Locking ' <br /> p Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locki,,g Cap Pinned Allenhead (DWP) <br /> Si�~�a�ure <br />