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DOULOS ENVIRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: U Sampling Date:51 S <br /> Site: Project No. :Lft <br /> � Well Designation: <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? NO YES Above TOC Below TOC <br /> Is top of casing cut level? 90? <br /> 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" UV_ 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer::_ Teflon bailer: <br /> Well Diameter: 2" 4"-i , 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2. 61 gal/ft. <br /> Initial Measurement Recharae Measurement <br /> Time: U- ', Z S�" Time r-T52 Calculated purge: _�-4' -a tAL <br /> Depth of well: Depth to water: Actual Purge: <br /> Depth to water: (,.2 Co D 1 <br /> Start purge: 4— 2 8 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> q- 3 L- 7 '� 2 . -7 7, L+7 <br /> � ',371 (P 7 739 - 2 <br /> 16 , 9 7 lo q -7 , 3 � 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: 4�L 4L,�� <br />