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1 <br /> DOULOS ENVIRONUENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: S ! t r <br /> Site: �r�i Project No. : <br /> 7 <br /> 1 <br /> LAk-/an Well Designation: 0!!J <br /> L <br /> Is setup of traffic control devices required? YES time; hours <br /> 1 Is there standing water in well box? 5 Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? F <br /> If no, see remarks <br /> Height of well casing riser (in inches) ': <br /> Well cover type: 8" UV12" UV _ 1211 EMCO 8" BK <br /> 12" BK 12" DWP 1211 CNI 36" CNI Dlher M D <br /> 1 General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> PVC bailer Centrifugal pump <br /> 1 Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 4" 6" B" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft . <br /> ime : Time: /1 : r0Calculated purge: � <br /> Depth of well : ' 7 Depth+o water; Actual purge: <br /> Depth to water: <br /> Start purge : Sampling time: �- <br /> Time Temp... E.C. pH Turbidity Volume <br /> o 6 <br /> zS • I Z <br /> Sample appearances Lock; L v✓ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 ;- 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap; Pinned Allenhead (DWP <br /> ORemarks ; <br /> Signature : <br />