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. DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: 2n.r'd lig Project No. : <br /> r6/� f/1., X191.A Well Designation: n <br /> .� GA <br /> Is setup of traffic control devices required? YES time; hours <br /> Is there standing water in well box? Wo <br /> Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NOS If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" LTV 12" LTV 12" EMCO 811 BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other_) /uC© <br /> General condition of wellhead assembly: Excellent LEM Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:,7� Teflon bailer: <br /> f Well Diameter: 2" 4114 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1 . 47 2 . 61. gal/ft. <br /> -initial Measurement Recharcre Measurement O <br /> Time: = Time: Calculated purge; <br /> Depth of well • G�!' S'/ Depth to water: Actual purge <br /> Depth to water: <br /> Start purge: (60 Sampling time: '-3 <br /> t <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1 <br /> t <br /> � 2 77- 1 �- �Z 7 - 5 ( <br /> CF 21 76- -0 tf '4-© ,?o <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 /> 411 Locking Cap: Lock-Dolphin; 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature- <br />