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SAMPLING INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL COMPANY <br /> Client: Sampling Date: <br /> �L7 <br /> Site: Project No- :AL--'1 <br /> �?°�,i.n�., � � <br /> . Well Designation: <br /> Is setup of traffic control devices required'� � YES tiro e•TOC Below TOC <br /> hours <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? � <br /> Height of well casing riser (in inches) ;l�V � -12„ EMCO 8" BK <br /> Well cover type: 8" UV .� 361, CNx,� other <br /> 12" BK 12" DWP 12" CN2�� 3 <br /> Excellent Fair Poor <br /> General condition of wellhead assembly: <br /> 2" disposable bailer Submersible pump <br /> Purging Equipment: 21+ PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" <br /> 411 6,r g t� <br /> 0. 65 1. 47 2 . 61 gal/ft. <br /> Purge Vol. Multiplier: 0 . 16 Rechar e Measurement -� <br /> Initial Measurement O Calculated purge• c <br /> Time: -cJ© Time: Actual purge <br /> Depth of well. 66- Depth to water:- S d p g <br /> Depth to water: 0 <br /> start purge: <br /> � Sampling time• L? { <br /> Time Temp. E.C. pH Time <br /> Volume <br /> 6-7 l <br /> �,��_�r1Lock: <br /> Sample appearance: <br /> �— <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 /> Pinned A1lenhead (DWP) : <br /> 6" Locking Cap•� <br /> Remarks: <br /> Signature: <br />