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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date* <br />• Site : 6 I Project No. : <br /> 4-,4 Well Designation• �w 3 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? N YES Above TOC Below TOC <br /> Is top of casing cut level'P NO Ka 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) : +/6 <br /> Well cover type : 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12 " DWP �yCNI� 36" CNI Other <br /> General condition of wellhead assembly: Excellent 52EM 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:X__ Teflon bailer <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft . <br /> InItial Measurement Recharcre Measurement <br /> Time: 7s y �� Time: f Calculated purge: � <br /> Depth of well : Depth to water: Y'l Actual purge : --- <br /> Depth to water: <br /> Start purge • 1 2-- ' / n Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> e 7 3 7 -/S z <br /> �Z r3 70 f- 72 7 rG 3 <br /> I Z r 3 70 71 7 0,0 --� <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: Lack-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature. <br />