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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client; <br /> Sampling Date• iZi <br /> iSite• f Pro]ect No. <br /> . .�-3 56 Well Designation: MW=3 <br /> Is setup of traffic control devices required? N6 Y S time: hours <br /> Is there standing water in well box? NO Above TOC Be w C <br /> Is top of casing cut level? NO If no, see remar s <br /> Is well cap sealed and locked? NO YES If no, see remarks <br /> Height of well casing riser (in inches) : -+ <br /> Well cover type: 8" UV12" W 12" EMCO_ 8" BK <br /> 1211 BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellen_t_(ooj Fair Poor <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:_x__ Teflon bailer: <br /> Well Diameter: 2" 411 6" $" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 7.j2 - Time: Cf 33_ _ Calculated purge: 66.z <br /> Depth of well: Depth to water: 5!1 f 6 - Actual purge: 66• �- . <br /> Depth to water: <br /> Start purge: Sampling time: 9iP <br /> Time Temp. E.C. pH Turbidity Volume <br /> 905 <br /> 17 <br /> X30 �s 7 gt 33 7t <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Lacking Cap: Lock #3753 • 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: z <br /> f <br />