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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: __ Sampling Date: _ 2 <br /> Site: Project No. : <br /> �61Well Designation: <br /> 4} <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 If no, see remarks <br /> Is well cap sealed and locked? NO CMif no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 1.2" W 12" EMCO 8" BK <br /> 12" BY 12 " DWP 12" CNI 36" CNI Other 1 t► <br /> General condition of wellhead assembly: Excellent 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: -.5' Teflon bailer: <br /> 1 <br /> Well Diameter: 2" 4'+ 6++ 8++ <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> . <br /> Initial Measurement <br /> Recharge Measurement <br /> Time • .r Time : ' D Calculated purge: <br /> Depth of well : t Depth to water: Actual purge: 1_2 <br /> Depth to water: <br /> Start purge : IP -50 Sampling time: 2 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1010 1 / I IK-- 4101 . <br /> Sample appearance: Lock: o /f S -t- <br /> Equipment <br /> Equipment replaced : (Check all that apply) Note conditionof replaced item <br /> 2 " Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks - <br /> signature. <br />