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r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: U&-l-G�� Sampling Date• "i ` I "-/ <br /> Site : L�6'Y / _ Project No. : <br /> %� % d E I7ct/?r�lrr�-per S-4m.0 Well Designation: !M w <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 0 Y Above TOC Below TOC <br /> Is top of casing cut level? No If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : '-1 <br /> Well cover type : 8"" W 12" W 12" EMCO 8" BK <br /> 12" BK 12 " DWPCNI �K- 36" CNI Other <br /> General condition of wellheassemobly: 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: 211 <br /> -)� 49' 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time - 7 O Time: o Calculated purger 0 <br /> Depth of well - 7 3 Depth to water: / Actual purge. <br /> Depth to water: <br /> Start purge : o Sampling time: ff •' ©� <br /> Time Temp. E. C. pH Turbidity Volume <br /> � q 1 ( �U � • 36 —� t <br /> �o3 7a t � 3 <br /> �o-s �© • 6 /o g 7 z o �-�— <br /> Sample appearance: Lock- <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <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 />