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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFoRMATION SHEET <br /> Sampling Date: 3` .l7-i <br /> Client: <br /> ' r Pro)ect No. :�Lf-• ��� <br /> Site: <br /> - Well Designation: nz `3 <br /> YES time:_ hours <br /> Is setup of traffic control devices required �O YES AboveTOC Below TOC <br /> Is there standing water in well box NO If no, see remarks <br /> Is top of casing cut level? If no, see remarks <br /> is well cap sealed and lacked? NO_ <br /> Height of well casing riser (in 1211 <br /> 2 1 c Uv} ' 12" EMCO ,8_11.. BK <br /> Well cover type: S" W �� 3 6" CNI Other ' t' <br /> 1211 BK_ 121t DWP 12 CNI Fair Poor <br /> General condition of wellhead assembly: Excellent o <br /> ui 2" disposable bailer Submersible pump <br /> Purging Equipment: 2++ PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:— Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 <br /> 1. 47 2 . 61 gal/ft. � <br /> Initial easurement Rechar e Measurement <br /> Time: O Calculated purge: <br /> Time: 7 Actual urge: <br /> Depth of well: 8 Depth to water: pt <br /> Depth to water: S <br /> Start purge: Sampling <br /> Time Temp. E. C. <br /> pg Turbidity Volume <br /> 9 rt y0 i � 1 <br /> - <br /> 5 1 Q 1 oS q � � � � <br /> � t <br /> S 9 i o 7 f '_--__ <br /> I <br /> Sample appearance: r� &AA Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 :^� 7/32 Allenhead:__ <br /> 9/16 Bolt: <br /> 4" Locking Cap: Lock-Dolphin:�� <br /> 6" Locking Cap: Pinned Allenhead (DWP) :- <br /> Remarks: <br /> S ? <br /> i nature: <br />