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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date Q - H ©d <br /> -- - , <br /> Site : 6�/ Project No <br /> /. ' / d E �q/ �y i/nJ Well Designation: yw` 7 <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) : 7f / A <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 1211 BK 12" DWP ��CNI�'<- 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo 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 easureme t Recharge Measurement <br /> Time ' -7 ' ,a 0 Time: ! Calculated purger <br /> Depth of well . S� 3 Depth to water; �• d' Actual purge. -- -L( <br /> Depth to water:_`f,7 , / <br /> Start purge: - /I �{ Sampling time: l <br /> Time Temp. E. C. pH Turbidity Volume <br /> JVY2- 1619) 7 - 30 --- <br /> IL S 0 6 7. t- <br /> (r yS 70 q 7 .2 --- <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 />