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i) <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Sampling Date <br /> Site Project No �+ <br /> Well Designation t+�„7 <br /> is setup of traffic control devices required? YES tirne hours <br /> la there standing water in the well box? YES Above TOC Below TOC <br /> Is tap of casing cut level? O If no, see remarks <br /> Is Nvell cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12" UV 12" EMCO 8" or 12" BK 8" Christy <br /> 12 Christy 8" M&D 12" M&D 12"DWP <br /> 12 CN'1 36" CNI 12" Pomeco Other ` <br /> General candir)on 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" 411 S). 8„ <br /> Purge Vol Multiplier 0 16 7_65 1 47 2 61 gal/ft <br /> lninal Measure ent Recharge Measurement <br /> Time Time Calculated purge <br /> Depth of well L Q Depth to water ?/ Actual purge <br /> Depth to water <br /> Stam purge 70 <br /> Sampling time ., <br /> Time Tem erature E C pH Turbidit Volume <br /> i o - �. c <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 AlIenhead <br /> 4" Locking Cap Lock-Dolphin 9116 Boir <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emGrks <br /> S3'?n3ttlre <br />