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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client : eve ate„ _ Sampling Date : <br /> Site: 1 �6�I _ Project No. : <br /> /.2, Well Designation- VW -7 <br /> Is setup of traffic control devices required�� YES time * <br /> Is there standing water in well box? hours <br /> Is top of casing cut levels YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO if no, see remarks <br /> Height of well casing riser (in inches) : 7P <br /> if no, see remarks <br /> well cover type : 8" UV 12" 121' EMCO <br /> 1211 BK 12 " DWPCNI Z_ B" BK <br /> General condition of wellheadassembly: Excellent oo3611 CNI therFair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with - Disposable bailer- 1K Teflon bailer <br /> Well Diameter: 2"_X 4" 6" g„ <br /> Purge Vol Multiplier: 0 . 16 0 . 65 1 47 2 63 <br /> • gal/ft <br /> initial Measureme t Rc <br /> ehar e Measurement <br /> Time O Time :_f� yJ - Calculated purge - <br /> Depth of well Ss- Depth to water: Actual purge <br /> Depth to water: <br /> Start purge : 2 3 Sampling time:— IL <br /> Time Temp. E. C. pH Turbidity Volume <br /> �Z -3 - ? <br /> �- <br /> �2 3S 67 -7 -Z,4' <br /> 2- <br /> Sample <br /> Sample appearance: Lock <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock , 3753 : <br /> 4 " Locking Cap: Lock-Dolphin: 7/32 Allenhead : <br /> 6" Locking Cap: 9/16 Bolt : <br /> Pinned Allenhead (DWP) : <br /> Remarks . <br /> Signature - <br />