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DOULOs ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: ,\A „ Sampling Date: <br /> Site: 6 Project No. : <br /> a 90 .5 �f � Well Designation: <br /> Is se-Lup of traffic control devices required? YES time: hours <br /> Is '.here standing water in well box? U S Above TOC Below TOC <br /> Is top of casing cut level? IN S If no, see remarks <br /> Is well cap sealed and locked? X10 If no, see remarks <br /> Height of well casing riser (in inches) : E-t <br /> Well cover type: 81/ W 1211 W 1211 EMCO 811 BK <br /> 12" BK 1211 DWP 1210 CNI 3614 CNI Other <br /> General condition of wellhead assembly: Excellent 664 Fair Poor <br /> Purging Equipment: 219 disposable bailer Submersible pump <br /> 214 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:- Teflon bailer: <br /> Well Diameter: 2" 4" 6P1 all <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: _n3 a Time: A I K - Calculated purge: �3 <br /> Depth of well: ?D• d� Depth to hater: �- Actual purge: 13 <br /> Depth to water: CS.0� <br /> Start purge: L 0 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> -165 C LQ /.2-J 7 V / <br /> . 2- Jai 7. f�_7 <br /> 302. K 3, 7 3 <br /> Sample appearance: 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 /> 644 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />