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DOULOS ENVIRONMENTAL COXPANY - SAMPLING INFORMATION SHEEN' <br /> f v� <br /> Client: Sampling Date; <br /> Site : o��l�� �.��1 Project No. <br /> 13'6 00 POh-IG4n jjgWell Designation: w <br /> Is setup of traffic control devices required YES time: hours <br /> Is there standing water in well box? �i?YES Above TOC Below TOC <br /> Is top of casing cut level? No if no, see remarks <br /> Is well cap sealed and locked? No._ If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" W 12'1 UV 12" EMCO 8" BY <br /> 12" BK 12" DWP 12" CNI 36" CNI her_ M o S <br /> 1 General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 Sampled with: Disposable bailer:_ Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1, 47 2 . 61 gal/ft . <br /> 1 • Initial Measurement Eecharcre Measurement <br /> Time: Time; Jzoa Calculated purge: <br /> Depth of wel17.16- 11f Depth to water: A0, 6 0 Actual purge: <br /> Depth to water; - 4 <br /> TT Start purge: Sampling time: ' 0 <br /> Time Temp.. . E.C. pli Turbidity Volume <br /> -7 -7- 1 r <br /> 0 1/1 5q -7 q 70 L 7 / 8 3 <br /> 1 Sample appearances Lock: 41— <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 /> 1 <br /> Remarks: <br /> 1 Signature: �" <br />