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- DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling Date Z rt 3 ^ O <br /> Site Beacon #3W 3 6 4 ( Project No <br /> 1 Well Designation w 5 <br /> Is setup of traffic control devices required'? YES tune hours <br /> Is there standing water in the well boxy YES Above TQC Below TOC <br /> Is top of casing cut Ievel7 NO If no, see remarks <br /> Is well cap sealed and locked? NO Y If no, see remarks <br /> Height of well casing riser(in inches) +- 10 <br /> Well cover type 8" or 12"UV 12"EM CO 8"or 12"BK 8"Christy <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> 12"CM NI�� 12"Pomeco Other <br /> General condition of we ad 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 C Teflon bailer Disposable Tubing <br /> Well Diameter 2" �� 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time y 6 Time "I = ? C7 Calculated purge j L <br /> Depth of well L1 d Depth to water ?• O Actual purge <br /> Depth to water y 6 S1 <br /> Start purge '�I- "2 Sampling time = 3 <br /> Time Temperature EC pH Turbidity Volume <br /> 0 <br /> 2 2 G Z 8 7 <br /> 23 �G' -7 S16 20 <br /> Sample appearance Lock zo <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolplun 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />