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F <br /> DOULOS ENVI,ROppNNMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client : Sampling Date: <br /> Site : _6 Project No <br /> Well Designation: yw S <br /> G <br /> Is setup of traffic control devices required? YES time. hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut levels o 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" 12" EMCO 8" BK <br /> I211 BK 12 " DWP Isembly; <br /> NI� 36" oo CNI Other <br /> General condition of wellh'ea�' Excellent 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:—�—<— Teflon bailer, <br /> Well Diameter: 2" 4" 6" 8 " <br /> • Purge Vol Multiplier- 0 . 16 0 . 65 1 47 2 61 gal/ft <br /> initial Measurement Recha e easurement <br /> T une Time : Calculated purge . <br /> Depth of well :— y�' 7S Depth to water: Ll y Actual purge <br /> Depth to water. <br /> Start purge _)_ / '6' Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7 . 3 Z <br /> 780 7- e) <br /> Sample appearance: Lock• <br /> Equipment replaced: (Check all that apply) Note condition of replaced iter <br /> 2 " Locking Cap: Lock #3753 : 7/32 Allenhead <br /> 4 " Locking Cap: Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks <br /> Signature <br />