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DOULOs ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: gAJINJ- 'ti , Sampling Date: <br /> Site: 60 <br /> 6 Project <br />• s S41 Well Designation: <br /> CC4- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in will box? 4 YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : _ <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Cher <br /> General condition of wellhead assembly: Excellent Gpad Fair Poor <br /> Purging Equipment: r _2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> �in uni o�nnsnm <br /> Well Diameter: 2" X 419 611 8!4 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: / n 6 Ll Time: I-Li,3 Calculated purg e: z 3 <br /> Depth of well: -6�. _ Depth to water: 6 5,0 14 actual purge: 2- 3 <br /> Depth to water: <br /> Start purge: 1277 Sampling time: 1­2d5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2-2-- ,L 11 4L L -------------- <br /> 2-30 <br /> �2-30 W /a 7, 4.z <br /> D6 7. Ll /0 7, 17 - <br /> Sample appearance: aDe!n. Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />