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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:_9ii" e;-30- - ) <br /> Site: _ _.4 lei _ Project No. <br /> �3 se Well Designation: <br /> Is setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box? X0`7 YE Above TOC Below TOC <br /> Is top of casing cut leve1'�' �p� If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) <br /> Well cover type: 8" UV 12" W 12"1 EMCO3; 811 BE <br /> 12" BE 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo 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: 2" 4"X 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:, U - 06 Time: Calculated purge: �3 S <br /> Depth of well: Depth to water: Actual purge: <br /> Depth to water: 53 -02 <br /> Start purge: Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 3011 -0-66 A spa <br /> Sample appearance: 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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: l/ <br />