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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> site: 4-e-� Project No. : q �� <br /> 401 Wk-4 Well Designation:�`N' <br /> L6--e,b, (./' <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? N 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" UV 12" UV 12" EMCO 8" BK <br /> 12" BR 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 /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:y Teflon bailer: <br /> Well Diameter: 2" 4"—X— 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time:_ 115 Calculated purge: <br /> ,,..., Depth of well: 'MMDepth to water: 1, I Actual purge: <br /> Depth to water: 81,71 <br /> Start purge: Sampling time: 32S <br /> Time Temp. E.C. pH Turbidity Volume <br /> L.�° <br /> 2 17 <br /> Sod 2. 7J53 <br /> 31 � 3 ISy� 7• <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: i 9/16 Bolt: <br /> 6" Locking Cap: Pinned A117enhead (DWP) : <br /> t.._ Remarks: <br /> Signature: <br />