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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: C&%C.1&- Sampling Date: 6—�- 6f-oc <br /> Site: an_e_ ,.._„ Project No. • �~ <br /> fir Well Designation: <br /> Is setup of traffic control devices required' 45P <br /> YES time: hours <br /> Is there standing water in well box? 0Q X3 <br /> Above TOC Below TOC <br /> Is top of casing cut level? NO 55If no, see remarks <br /> Is well cap sealed and locked? NOE If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 81' BK <br /> 12" BK 12" DWP 12" CNI 361' CNI Other_ I_C_' 1q V <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—E 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 /> i Time: = Time: "- C q Calculated purge: �• � <br /> Depth of well . 'b, Depth to water:. Actual purge: �o 'CJ <br /> Depth to water: 1,5"- 60 _ <br /> i <br /> Start purge: ' '0 Sampling time• 1� t c�xD <br /> 4 <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearance: Lock: <br /> r <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 />