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r <br /> F' <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> j Client: �- Sampling Date: <br /> Site: -¢ ' � Project No. : <br /> 0 Ewell Designation: Ai W` <br /> y <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? - YES Above TOC Below TOC <br /> Is top of casing cut level? N E If no, see remarks <br /> I' Is well cap sealed and locked? N If no, see remarks <br /> I Height of well casing riser (in inches) - <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI then <br /> General condition of wellhead assembly: Excellent oo Fair Poor? <br /> Purging Equipment: .X 2" disposable bailer Submersible pump . <br /> 2" PVC bailer Dedicated bailer,. <br /> 3 4" PVC bailer - Centrifugal pump; <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" $" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2.61 gal/ft. <br /> j Initial Measurement Recharge Measurement <br /> Time: 665 Time: f, 3 Calculated purge: <br /> Depth of well: 21 .12 Depth to water: Actual purge: & E _ <br /> Depth to water: IM6K <br /> Start purge: 1 Sampling time: '674.0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> a. <br /> 610 -2 17 <br /> a' <br /> 0-5- <br /> 630 <br /> -5 630 69.3 L4 Ijp 7.7 -� <br /> C36 <br /> { Sample appearance: _r�/ r Lock.- <br /> Equipment <br /> ock:Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: ( ) • <br /> Pinned Allenhead DWP . <br /> #� Remarks: <br /> I <br />