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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client <br /> Sampling Date <br /> Site Project No <br /> Well Designation <br /> is serup of rraffic control devices requtred9 YES <br /> Is there standing water to the well box9 time hours <br /> Is lop of casing cut levels Y Above TOC Below TOC <br /> O If no, see remarks <br /> Is ,veil cap sealed and locked NO <br /> Heigh, of well casing riser (in inches) 3 If no, see remarks <br /> Well cover rype 8" or 12" UV 12" EMCO 8"or 12"BK <br /> 12 Chas 8" Christy <br /> rY 8" M&D 12" M&D 12" DWP <br /> 12 CNN 36" CNI 12" Pomeco Other <br /> CeneraI condrnon of wellhead assembly Excellent Good Fair <br /> Poor <br /> Purging Equipment 2" disposable bailer <br /> Submersible pump <br /> 2" PVC bailer 4" PVC bailer Dedicated bailer Sampled with Disposable bailer Teflon baCentrifugal pump <br /> ler isposable Tubing <br /> Well Diameter 2" 4" 6>> <br /> Purge Vol Multiplier O 16 065 1 47 <br /> [nidal Measurement2 61 gal/ft <br /> Rechar e Measurement <br /> Time Time _Z <br /> Depll� of well 0. �0 --J2S Calculated purge <br /> Depth to water Z . �/ purge <br /> e <br /> Depth to water G p g <br /> Starr purge Sampling p g time <br /> Time Tem erature E C H Turbidit Volume <br /> c/7 9 <br /> Sample appearance <br /> LockO <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 AlIenhead <br /> Y" Locking Cap Lack-Dolphin 9/16 Bolt — <br /> 6" Locking Cap _ Pinned Allenhead (DWP) <br /> �e^�arks <br /> S�vnalure <br />