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'+ • is S [ <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: (q - 1' 9- C90 <br /> Site: Project No. : <br /> Well Designation: <br /> CA <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? NO tM 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" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other—( 9, ITF7T4 <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S Teflon bailer: <br /> r Well Diameter: 2" 4"_ 6" 811 <br /> s Purge Vol . Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft . <br /> Initial Measurement Rechar a easurement <br /> i Time; <br /> Time: (_0 IVY, <br /> Calculated purge: 7- 6 <br /> ' Depth of well : C3 , 3 Depth to water: -"c7 , D Actual purge . 7 <br /> Depth to water: <br /> i <br /> s Startg �.Q �O SO <br /> pur e• Sampling time: <br /> s <br /> Time Temp. E. C. pH Turbidity Volume <br /> s <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 /> E <br /> { <br />