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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date ` Co` 6 <br /> Site _ Project No <br /> Weli Designation /"Z &4-/ <br /> Is serup of traffic control devices required9 YES <br /> Is (here standing water in the well box9 time hours <br /> YES Above TOC Below TOC <br /> Is lop of casing cut level? NO <br /> Is ~veil cap scaled and iocked9 If no, see remarks <br /> NO If no, see remarks <br /> Heigh{ of well casing riser(in inches) <br /> Well cover type 8" or 12"W l2" EMCO 8"or 12" BK <br /> 12 Chris 8" Christy <br /> i? C*!I ry 36 ' CN&D� 12" M&D 12" DWP <br /> 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Good <br /> Fair Poor <br /> Purging Equipment 2" disposable bailer <br /> Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> _4" PVC bailerCentrifugal pump <br /> Sampled with Disposable bailer X Teflon bailer <br /> tsposable Tubing <br /> Well Diameter 2" 4" 6" <br /> 8„ <br /> Purge Vol Multiplier 0 16 065 —F4—7 <br /> InitialMeasurement Recharge Measurement 2 61 gal/ft <br /> Time �10-0/ <br /> Time ; e- <br /> Depth of weCalculated purge <br /> Depth to water Actual purge t Q <br /> Depth to water <br /> Start purge Sampling time j< <br /> Time Tem erasure EC <br /> �� 'r,� H Turbid2t VolumeY 2 ' <br /> .20 . .- <br /> C� <br /> Sample appearance Lock o Ff <br /> EQuipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking CaD Lock 7/32 AlIenhead <br /> K" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned P,llenhead (DWP) <br /> S��nature � <br />