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' <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: <br /> Sampling Date . 3` •Z 7'1 � <br /> ej - <br /> " Project No. <br /> Site• <br /> Well Designation: <br /> 2.3 50 <br /> e• hours <br /> Is setup of traffic control devicesrequired? `r� YES e.TOC Below TOC <br /> Is there standing water in well box' T� YES time: <br /> Above <br /> see remarks <br /> Is top of casing cut level? NO TET If If no, see remarks <br /> Is well cap sealed and locked? NO <br /> Height of well casing riser (in inches) : 811 BK <br /> Well cover type: 8" UV12 It W 12" EMCO_11-1� _ <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent 7 Fair Poor <br /> [� <br /> .� <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" <br /> 4 it 61 <br /> 0 8„ <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: Calculated purge: � <br /> Actual purge: y G _ <br /> Depth of well: �" � Depth to water:_=L ( <br /> f <br /> Depth to water: <br /> Start purge: ' W Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> Cl <br /> I06.Y <br /> o <br /> Sample appearance: <br /> er�y.� 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 /> �� s <br /> Pinned Allenhead (DWP) : <br /> 6" Locking Cap: <br /> � <br /> Remarks: <br /> Signature: <br />