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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> iSite : _6 / Project No. : <br /> /� d E T7a/tn�rr�p _ mL Well Designation: VW - 1 <br /> Is setup of traffic control devices required? YES time. hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked NO If no, see remarks <br /> Height of well casing riser (in inches) : _o► <br /> Well cover type : 8" UV 12" UV 12" EMCO 8" BK <br /> 1211 BK 12 11 DWP XlLNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent ;o l Fair Poor <br /> Purging Equipment: 21' 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"_y1.:__ 4" 6" 81 <br /> ' <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft <br /> Initial Measurement_ Recharge Measurement Z 3 <br /> Time. 7 /0 _ Time: / 3(f2 Calculated purge : <br /> Depth of well : S S Depth to water: �y?3 ^ c9Z Actual purge : 2 <br /> Depth to water:V 7 �Q <br /> Start purge . 1 0-0 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> /0 -7 31 <br /> /09c( -7 • ZS <br /> 23 6q ' /09 ( 7 '90 3 <br /> Z 1I 6 '7 logo 7 e_a <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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />