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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:_. 7 <br /> site: 41el Pro3ect No- :_ qY III -O <br /> 3 5 0 Well Designation: <br /> Is setup of traffic control devices required O 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) : 3 <br /> Well cover type: 8" UV 12" UV 12" EMCO $" BK <br /> 12" BE 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goo 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" 61' 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: IID 1- Time: /11_ Calculated purge r <br /> Depth of well: ► >epth�t• water: X- Actual purge: a 9 <br /> Depth to water: *34,7 4 <br /> Start purge: //�7 _ Sampling time:_/11 ,1� <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1.X16 r 03 1337 75)- <br /> 67- <br /> Sample <br /> 5)-s7-Sample appearance: r Lock: al&fr�_ <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:r <br /> 6" Locking Cap: Pinned Allenhead (DWP) : ._. <br /> Remarks: <br /> Signature: <br />