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s <br /> , DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: -©c <br /> Site: a .rr4- � _ Project No. : � <br /> f 6/.� _ _ Well Designation: <br /> Is setup of traffic control devices required? YES time: houre ' <br /> Is there standing water in well box? N YES Above TOC Below TOC <br /> Is top of casing cut level? 0 if no, see remarks <br /> Is well cap sealed and locked? NO, E If no, see remarks <br /> Height of well casing riser ( in inches) : X <br /> Well cover type: 8" UV 12" UV 121' EMCO 8" BK � <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good < ai 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: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> . Initial Me surement Rechar Measurement q l� <br /> Time: Q Time: - Calculated purge: <br /> Depth of well : � ` Depth t water: S, 6� Actual purge r <br /> Depth to water: <br /> 1 <br /> s Start purge: - Sampling time: s� <br /> Time Temp. E. C. pH Turbidity Volume <br /> r <br /> = sgo -� z1g9 6- 01 3 <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 />