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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• Sampling Date:,3- 7 <br /> Project No. : q` q 7 `0 <br /> Site: - <br /> 3 Well Designation:M <br /> _ <br /> Is setup of traffic control devicesrequired? O YES time: <br /> hours <br /> Above TOC Below TOC <br /> Is there standing water in well box., If no, see remarks <br /> Is top of casing cut level? If no, see remarks <br /> is well cap sealed and locked? N q <br /> Height of well casing riser (in inches) : 12„ EMCO�i 8" BK <br /> Well cover type: 8" W 12" W „ ther <br /> 12" BK 12" DWP 12" CNI 36 CNI <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: _211 disposable bailer _Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:—/I— Teflon bailer: <br /> Well Diameter: 2" <br /> 4 11 X 611 Sit— <br /> Purge <br /> "purge Vol. Multiplier: 0. 16 <br /> 0. 65 1.47 2. 61 gal/ft. <br /> itial Measurement I echar a Measure m e n t 2��K <br /> .© Time: Calculated purge: <br /> Time: ,6 Actual purge:�'2 •9 <br /> Depth of well: �9' Depth to water: <br /> Depth to water- • 3 <br /> Start purge: � U' Sampling time: 9- 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 4, <br /> CD q <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 /> Lock-Dolphin: <br /> 9/16 Bolt: z <br /> 4" Locking Cap: p <br /> 611 Locking Cap: pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />