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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: AA • sampling Date: 1.�-6 <br /> Site: -6,6n 4/9_ Project No. : 9 <br /> �050 ah� trot Well Designation: �- <br /> 1 <br /> Is setup of traffic control devices required? YES time: hours <br /> (N <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 9 <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI � Other <br /> General condition of wellhead assembly: Excellent poog Fair Poor <br /> Purging Equipment: 2„ disposable bailer Submersible pump <br /> 2 PVC bailer Dedicated <br /> ler <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer:, Teflon bailer: <br /> Well Diameter: 2" 4"__­Y�' 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 4. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 1-2- Time• a ", <br /> Calculated purge: x- <br /> Depth of well: G 7,�' Depth to water: f-3 Actual purge; z <br /> Depth to water: <br /> Start purge: 750 Sampling time: ?0 6 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 756 )6Z )5044- 2-6 - 2 <br /> Sample appearance: C"/_r,, 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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />