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, DOULOS ENVIRONUENTAL COUPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> 3 • Site : 4&&j ZZ; � IIIC 2Za4a dL Project No. ; <br /> CIF <br /> n R&W Well Designation: <br /> t � � <br /> F <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? N0� E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI_ 36" CNI her M 7 r <br /> O 0 <br /> General condition of wellhead assembly; Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> -2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> t 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 /> Initial Measuremen RecAarcrg Measurement Time: Tim <br /> Calculated purge: S' � <br />► e: <br /> Depth of well ; O• DDepth to water: Id o,5 Actual purger <br /> Depth to water: • O <br /> Start purge: Sampling time: �` y <br /> S <br /> Time Temp,.. E.C. pH Turbidity Volume <br /> �: r] /SC7 <br /> � • r � �� / yo 7- � O �` Z <br /> r 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 />