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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br />• <br /> Site: Project No. : <br /> Well Designation: : <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? 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 91 <br /> Well cover type: 8V 12" UV 12" EMC <br /> 8" BK <br /> " U <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <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 pump <br /> Sampled with: Disposable bailer: X„T- Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:, W 7 Time: 644 Calculated purge: �. <br /> Depth of well: 635 Depth to water: Actual purge: �sr» <br /> Depth to water:0 91- <br /> Start purge: Sampling time: 6L� <br /> Time Temp. E.C. pH Turbidity Volume <br /> 631 72-c Z46 1 <br /> 633 2#o 1915 7Jo z <br /> C35 <br /> C3 � S 951. 7 <br /> Sample appearance: fZzA.. . Lock: <br /> 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 />• 601 Locking Cap: Pinned Allenhead (DWP) :�_ <br /> Remarks: <br /> Signature: <br />