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SAMPLING INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL COMPANY <br /> Client: �, �,,,�.�� Sampling Date:3 - <br /> .- <br /> Site: <br /> Pro3 ect No. • /F - 4--- _—j <br /> Well Designation: <br /> • hours <br /> Is setup of traffic control devices�required� �� YES D7 YES timeAbove•TOC Below TOC <br /> Is there standing water in well box. If no, see remarks <br /> Is top of casing cut level? NO OLE-S7) If <br /> no, see remarks <br /> Is well cap sealed and locked? NOy <br /> Height of well casing riser (in inches) -� g++ BK <br /> Well cover type: 81+ UV12" iw�z_ 12 EMCO Other <br /> 121+ BK 12" DWP 12" CNI 3611 CNI <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Submersible pump <br /> Purging Equipment: 2" disposable baler 2+' PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:—�� - 6+1 all <br /> Teflon bailer: <br /> Well Diameter: 2" 491 ;,L� � <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial easurement Rechar a Measurement <br />. Calculated purge: ) <br /> Time. © / 54j Depth to water: d- Actual purge: �J ✓f <br /> Depth of well. 3- r p {/ <br /> Depth to water: a, <br /> Start purge: �� � Sampling time: d2 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 202 <br /> Sample appearance: <br /> Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Ca Lock #3753 :— � 7/32 Allenhead:�-� <br /> g P:------ 9/16 Bolt:- ^ <br /> 4" Locking Cap: _ Lock-Dolphin:- — <br /> 6" Locking Cap: Pinned Allenhead (DWP) :�� <br /> Remarks: <br /> Signature: <br />