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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client :� cin. - Sampling Date: I- I y - 00 <br /> Site : 6.ql _._ Pro)ect No. <br /> �� d 17a/yr►irr�P�_d-ct Well Designation: OLAw <br /> /' i <br /> Is setup of traffic control devices required' YES time: hours <br /> N <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level' NO E 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 : 8" W 12" W 12" EMCO " K <br /> 12" BK 12" DWP 12" CNI 36" CNI Others �o�c <br /> General condition of wellhead assembly: Excellent o 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"->L 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft . <br /> Initial Measurement Recbarge Measurement 3 <br /> Time ' 416 Time: Calculated purge . <br /> Depth of well . 7/ - p0 Depth to water: Actual purge ,2G -• .� <br /> Depth to water: y 7 - <br /> Start purge : Sampling time : <br /> — 9, I/L <br /> Time Temp. E. C. pH Turbidity Volume <br /> 11 (�;8 3 730 7 f4 <br /> b q l 2 0 7 3 1 <br /> f 70 /0 <br /> Sample appearance: G✓�" 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 />