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1 DOULOS ENVIRONNENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Ad4c,�, G}74 Project No. : J <br /> J Well Designation:_A4 SII!` <br /> ! Is setup of traffic control devices required? IN <br /> YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? E If no, see remarks <br /> Is well cap sealed and locked? O If no, see remarks <br /> Height of well casing riser (in inches) : - <br /> Well cover type: 8" UV 12" UV-IA--- 12" EMCO 8" BIC <br /> 12" BK 12" DWP 12" CNI 36" CNI er <br /> General condition of wellhead assembly: ExcellentFair Poor { <br /> ' Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump . <br /> Sampled with: Disposal bailer:- )r� Teflon bailer: <br /> Well Diameter: 2" 4" _ 6" 8" <br /> 4 Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. :' <br /> Initial Measurement RecharRg Measurement <br /> Time: 4it. Time: Calculated purge: 7 yS�' <br /> Depth of we lr1: 7y.rD Depth to water: 7Z0 f - Actual purge: �- 4 <br /> Depth to water• 6.72 <br /> Start purge: L � Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> J_ 16417 <br /> t 7�rO <br /> 7, 76 �} <br /> Sample appearance: Qzz Lock: <br /> I <br /> Equipment re laced: <br /> p (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 /> I <br /> Signature: �1 �f � ---•-- <br /> 1 <br />