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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: �- 1 `�-00 <br /> Site: L `6 Project No. : <br /> E17 <br /> ".ynAr AC�/rit Well Designation: w - <br /> G <br /> Is setup of traffic control devices required1lYES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO � If no, see remarks <br /> Is well cap sealed and locked? NO3 if no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other OL S M� <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: 5 P Teflon bailer: <br /> Well Diameter: 211 '?� 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 47 2 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time : 6 5Y Time: . Calculated purge. <br /> Depth of well : S y y� Depth towater: 9 ?0 Actual purge =4_ <br /> Depth to water: `f j-� 7 <br /> Start purge : v Sampling time: �^ <br /> Time Temp. E. C. pH Turbidity Volume <br /> Lf f '�;--1 3 /14Y -7 , 2 1 - <br /> 8- 42 6 � y 1/ 122 7 , If �— <br /> 70 . 6 lo Pc) 7 0e ` <br /> Sample appearance: CXrLrt 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 />