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r DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Q o Client: � ,-�. Sampling Date: <br /> Site:. ��� .� _..J Project No• 6Cky6 <br /> Well Designation: <br /> Is setup of traffic control devices required? 6 YES time: hours <br /> Is there standing water in well box? X9 eYES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 UV1214 W 12'4 EMCO_ 8 99 BK <br /> 12" BK 1211 DWP 1211 CNI f9 CNI __ Other <br /> General condition of wellhead assembly: Ecexa Good Fair Poor <br /> Purging Equipment: 291 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 444 PVC bailer Centrifugal pump <br /> _ /n_. � <br /> Sampled with: Disposal bailer: Teflon bailer: L <br /> Well Diameter: 211 499 614 --� 814 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: 5 Calculated purge: a�.,Z_ <br /> Depth of well: fLld Depth to water; Actual purge: J'V7 _ . <br /> Depth to mater: �� <br /> Start purge: .2 s Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1DL4, If <br /> Sample appearance: c_� Lock: , zzvt�A,_ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 40° Locking Cap: Lock-Dolphin: 9/16 Balt: <br /> 60 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: , 493 <br />