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{ DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET x <br /> Client: Sampling Date: <br /> f <br /> Site: w Project No. :­z?)4 -�7h-01_ <br />�• 3Well Designation: <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YgS Above TOC Below TOC <br /> Is top of casing cut level? IN 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" W 12" W _ 12' EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellentoo Fair Poor:. <br /> Purging Equipment: 2" disposable bailer Submersible pump' <br /> 2" PVC bailer Dedicated bailer'; <br /> 4" PVC bailer Centrifugal pumpl. <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4"4— 6" 8" <br /> i Purge Vol. Multiplier: 0.16 0. 65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 7 06 Time: 7Q Calculated purge _ <br /> Depth of well: U.1i Depth to water. 7702- <br /> Actual purge: 1 <br /> Depth to water: } <br /> Start purge: Sampling time: goo <br /> Time Temp. E.C. pH Turbidity Volume <br /> i <br /> 72' - Kz - : , 1 <br /> 3 le <br /> IS <br /> Sample appearance: C,ZaA--, Lock: <br /> L` <br /> • Equipment replaced: (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 /> i, 6" Locking Cap: Pinned Allenhead (DWP).: <br /> Remarks: <br />