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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• /t�irrtill/1i Sampling Date:_ 3"a — <br /> Project No. : y`L1 7 ~0 <br /> Site- <br /> 3 F <br /> Well Designation: <br /> 10 <br /> Is setup of traffic control devices required? hours <br /> � YES Atbave•TOC Below TOC <br /> me <br /> Is there standing water in well box. <br /> Is top of casing cut level? = NOIf no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : IL <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 Fair Poor <br /> Purging Equipment: 2" disposable bailer _ ._Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> -x_411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: , Teflon bailer: <br /> ,� <br /> Well Diameter: 2" 4 11 6 <br /> 8 lt <br /> Purge Vol. Multiplier: 0. 16 echar0. 6ae Measurem.47 2. 61 9i1/ft. <br /> I itial Measurement <br /> Time: <br /> Time:_( (:S ( Calculated purge: ° <br /> — <br /> Depth o well.: 83 � Depth to water:_ IG 4• � Actual purge: <br /> Depth to water <br /> Start purge:_ l O Sampling time: <br /> Time Temp. E.C. pH Turbidity :Volume <br /> 1i - 4 - KV 14 7 -73 0 <br /> 2 .9 R IO 7-1 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> Lock #3753 : .7/32 Allenhead: <br /> 2„ Locking Cap: g/16 Boit: <br /> 4” Locking Cap: Lock-Dolphin: <br /> 611 Locking Cap Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: �b - <br />