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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: wt,_a" Sampling Date: .3— Q'0 j <br /> iSite; e 4j -- -- Prod ect No. : <br /> F_ -r�m� Well Designation: M � <br /> G 71 <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 levels Rb If no, see remarks <br /> Is well cap sealed and locked' NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" UV 12" W 12" EMCO S" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other 12 jrlk7 <br /> General condition of wellhead assembly: Excellento9 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: L Teflon bailer: <br /> Well Diameter: 211 <br /> -4 4" 6'r 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft . <br /> Initial easu eme t Recharae Measurement 7 7 <br /> Time. O Time: ` <br /> Calculated purge* <br /> Depth of well : .r5 - S Depth to water: Actual purge <br /> Depth to water: <br /> Start purge: 0 Sampling time: . 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> -<9 8 C1 9 -7 .s I ---~- 1 <br /> 6L 99 <br /> lL 3 66 -f 8 r � • � I -�-- 3 <br /> : 2- o - yo <br /> Sample appearance: e� Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock x`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 />