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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION ' <br /> Client: Sampling Date: <br /> Site: /j Project No. : 14P-513'0/ <br /> Well Designation: Al w-3 <br /> Is setup of traffic control devicesrequired? YES time: <br /> im e•TOC Below TOC <br /> hours <br /> Is there standing water in well box.' If no, see remarks <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? <br /> Height of well casing riser (in 12�che 12" EMCO 8" BK <br /> Well cover type: 8" UV <br /> 12" BK 12" "DWP 12" CNI 36CNI Other <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> g 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: X Teflon bailer: <br /> Well Diameter: 2" <br /> 4" 611 8n <br /> Purge Vol. Multiplier' . 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Rec r e Measurement <br /> tee. Calculated purge: �• <br /> Time: �-� th o water 1- Actual purge:_t-+__1�___ <br /> Depth of well. 61 . 6 t <br /> Depth to water: -M. <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Loos 73 1 <br /> ! I oil -730 <br /> L f <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: "/�� <br />