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p,' A .,..wnzra....ryr+e�r:+ww+.7lC�GetusN,r�—�u <br /> Fti <br /> DOULOS ENVIRON=NTAL COMPANY - SAMPLINQ INFORMATION SHEET <br /> Client: Samplfng Date; r <br /> 3 . Site: eZ�L Project No. ; <br /> / n Well Designation: lilt <br /> i <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? If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 811 UV12 1' W 121f EMCO 8" BK <br /> 12" 8K 1211 DWP 1211 CNI 3611 CNI Other M 0 (Z:—/;�_ f <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> 1 Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft . <br /> Initial Measuremen. HeaguXglaent <br /> Calculated purge: <br /> • Time: Time: <br /> Depth of well: 8, 7 Depth to water: � � Actual purge ; <br /> Depth to water: • O <br /> Y1 Start purge: Sampling time: <br /> I Time Temp... LP. C. pH Turbidity Volume <br /> z . / 57 / 1 -7- 0 ('- 1 <br /> q 0 02 <br /> I Sample appearance: Lock: l <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock #37531 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP <br /> • Remarks: <br /> Signature : <br />