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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> • _ ��rn <br /> Site: 4M project No. :AL_ <br /> 1, sa W P_J Well Designation:_ <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 171 <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 12i1 BK 12" DWP_ 1211 CNI 3611 CNI 600t <br /> her <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:-k-_ Teflon bailer: <br /> Well Diameter: 2" 4",� 6" Big- <br /> Purge <br /> "Purge Vol, Multiplier: 0. 16 0. 65 1.47 2 .61 gal/ft. <br /> i easurement Recharge Measurement <br /> Time: Time: Q!n Calculated purge:a3 g <br /> Depth of well: lA� Depth to water: 6 k Actual purge: E5 <br /> Depth to water: P7/6 <br /> Start purge: 3-LO Sampling time: �4 a <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7/, a i z ! <br /> Wo 1�r0 7,r 2 <br /> Sample appearance: C99.1a, Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2f1 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> • <br /> Remarks: <br /> Signature: <br />