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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET ` <br /> Client: <br /> Sampling Date: <br /> � I'r� <br /> site: . <br /> Project No. • U- `�/ <br /> • Well Designation: I <br /> Is setup of traffic control devices required? YES time:__ <br /> hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> If no, see remarks <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO <br /> Height of well casing riser (in inches) : 12„ EMCO 811 BK <br /> " LT <br /> Well cover type: 8V 12 It UV--,-'S— Other <br /> 12" BK 12" DWP 12" CNI�_ 36„ CNI <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2” disposable bailer k Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> „�Well Diameter: 2" 4 611 8 ri <br /> Purge Vol. Multiplier: 0. 16 <br /> 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time•_ 7y!j _ Time• f�'tf q- Calculated purge: /• <br /> Depth of well: Vk. /U Depth to water: G Tf 13 Actual purge: <br /> Depth to water: 6 •.L <br /> Start purge:. X30 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> i�3 0 _6 <br /> grc f o b- 3 <br /> 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" 9/16 Bolt: <br /> Locking Cap: Lock-Dolphin: pinned Allenhead (DWP) : <br /> 6" Locking Cap: <br /> . Remarks: <br /> Signature: ` <br />