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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: � itrx_iyn/a�v Sampling Date: <br />. Site: Pro]ect No. _q LF- 4/q `4/ <br /> �.3 b �/ _ K.l��__ Well Designation: <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? RN S Above TOC Below TOC <br /> Is top of casing cut level'? NO If no, see remarks <br /> Is well cap sealed and locked? N � If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12 ' EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI then /('' <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailer _Submersible pump <br /> 21" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer-e� Teflon bailer: <br /> Well Diameter: 2" 411 6" 8" <br /> Purge Vol . Multiplier: 0 16 0. 65 1. 47 2 , 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ///, Time : /DL __ Calculated purge:�� <br /> Depth of well: r� Depth to water: G Actual purge: +�- <br /> Depth to water: 1'1. 36 <br /> Start purge: A-q7 Sampling time: 116 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 6s 7d j <br /> Sample appearance: Lock: - tn <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: _ <br /> 41" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) :,,1� <br />. Remarks: <br /> Signature: ``- <br />