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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> '. Sampling DateClient: ' <br /> Site: gg -� _ Project No. : <br /> Well Designation: <br /> Is setup of traffic control devices required? <n YES time: hours <br /> is there standing water in well box? YES Above TOC Below TQC <br /> Is top of casing cut level? IPIf no, see remarks <br /> Is well cap sealed and locked? NO le If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" UV12" EMCO 8" BK <br /> 1211 BK 1211 DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o 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:_)( Teflon bailer: <br /> Well Diameter: 211 4"-yr- 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br />•Initial Measurement Recharge Measurement /Z 7 <br /> Time:, Lid _ Time: Calculated purge. <br /> Depth of we11: 635 Depth to water: ao - Actual purge: i 7 <br /> Depth to water:�:e _ <br /> Start purge:. 5 D q Sampling time: 16 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 03 3 6 2 <br /> 7�O 3 <br /> I- q.s 4or <br /> Sample appearance: _c&:es 1 Lock: <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: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) :_^_ <br /> Remarks: <br /> Signature: <br />