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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> 7r� � <br /> Client: Sampling Date:�l <br /> Project No. : 24 - L/1 q ` 0 <br /> Site• <br /> • f Well Designation: -n-LI/LJ <br /> hours <br /> Is setup of traffic control devices required" (::Na) YES timAbove: Below TOC <br /> Is there standing water in well box. � �� If no, see remarks <br /> Is top of casing cut level? ' NO ES� If no, see remarks <br /> is well cap sealed and locked. <br /> Height of well casing riser (in inches) : 12" EMCO 8" BK <br /> Well cover type: 8" W 12 UV- Other <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNent oo Fair Poor <br /> General condition of wellhead assembly: <br /> _Submersible pump <br /> Purging Equipment: 211 disposable bailer Dedicated bailer <br /> 2" PVC bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:_ Teflon bailer: <br /> �/ <br /> Well Diameter: 2" 411 6t1 811—.4- <br /> fl, 65 1. 47 2 . 61 gal/ft. <br /> Purge Vol. Multiplier: 0' 16 Rechar a Measurement )) <br /> Initial Measurement 3 Calculated purge•—L <br /> Time: - <br /> � C Time C3j Actual purge:_ <br /> Depth of well: ��' ( Depth to water: <br /> Depth to water: <br /> �s Sampling time: <br /> Start purge:—� q= <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: <br /> / /� � Lock: ,a ,f�r!, . <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> Lock #3753 : 7/32 Allenhead:_� <br /> 2„ Locking Cap:�.�.—. 9/16 Bolt: <br /> 4” Locking Cap: Lock-Dolphin:.�� <br /> 6" Locking Cap: Pinned Allenhead (DWP) :r� <br /> Remarks: <br /> Signature: <br />