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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> OEM <br /> Client:_ �,L.frr�rn�iv Sampling Date: 6-30-Gr7 <br /> Site: 4 Pro3ect No. : 914- W L7 �OJ <br /> 2 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 E3j If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : �b <br /> Well cover type: 8" UV 12" UV \� 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> Go <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: 2" 411�_ 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0.. 665 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: /0S 14 Time: 1131- - Calculated purge: 1 3 <br /> Depth of well: 63,5 7 Depth to water: Actual purge: <br /> Depth to water U.c g <br /> Start purge: 111 Sampling time-M-) <br /> Time Temp. E. C. pH Turbidity Volume <br /> I <br /> o !.2-�-a 7 1 <br /> 7ja <br /> 6q. 7-z, 3 <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: 9/1b Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : .` <br /> Remarks: <br /> Signature: IZO�C �_ <br />