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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:_3=12 <br /> 7 7 <br /> Site: Project No. :_ 9q-g7L'r01 <br /> 0 q 1 n Well Designation: <br /> Gt. <br /> Is setup of traffic control devices required? <N@a) YES time: lJours <br /> Is there standing water in well box? NO I!P Above TOC o <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked. <br /> NO If no, see remarks <br /> Height of well casing riser (in12�chL�es)Lly- 12" EMCO 8" BK_ <br /> Well cover type: 8" UV_ <br /> 12". BK 1211 DWP_ 121' CNI 1 3611 CNI_ Other,_ <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer _PC Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump . <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> �r <br /> Well Diameter: 2" 4 116#1 Sol- <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2.61 gal/ft. <br /> Initi 1 Measurement <br /> Recharge Measurement 11� <br /> TiTime: me: 11 = 3 3— Calculated purge: <br /> Depth of well: Depth to water: fir- 7 D Actual purge:_.j �.7 <br /> Depth to water: Z0: <br /> Start purge: Sampling time: 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> rr • 2- t 7 3 • <br /> 1f : 2- 3 "13 . 6' r ? r7 �— ♦2 <br /> L- -7 3 . d Q90 7,�- 3 <br /> Sample appearance: Lock: 3�3 — mom <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap:__ Lock #3753 : .7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: _ ... <br /> 6t1 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />