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10/05/2000 05 39 9167829054 DOULOS PAGE 03 <br /> DOULOS ENVI ONMEMAL COMPANY SM100" INFORMATION SHEET <br /> • Client: sampling Date: `�- <br /> site: an&-� ,�1 6 �. Project No. <br /> Well Designation:,,, _ ` <br /> Is setup of tr ffis control devicea required? Q YES time:— hours <br /> Is there stand ng water in well box? RO Y S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap se led and locked? No E� If no, see remarks <br /> Height of wellIcasing riser (in inches) : <br /> Well cover typ sit UV 12 r' UV 1211 EMCO 8 1r 8K_— _ <br /> 12" BK i �" C?WP 1211 CNI 3611 CNI other /1'dl <br /> General condrt of wellhead assembly: Excellent Go Fair Poor <br /> Purging Equipne+l ' 2" disposable bailer Submersible pump <br /> _2" PVC bailer Dedicated bailer <br /> 411 PVC bailerCentrifugal pump <br /> Sampled with: Disposable bailer:_ Teflon bailer:___ . <br /> Well Ds�rzieter: lir 411 611 err <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2.61 gal/ft. <br /> Initial Ileasure ten <br /> Time: t'3e' Time: Calculated purge..—.—),, )� <br /> —Wj <br /> Depth of well . Depth to water: Actual purge: r1,X 9 <br /> Depth to water . r 1 <br /> start purge: Sampling time: <br /> Time Tpmp. E.C. pH Turbidity Volume <br /> LIS, 1}0e) <br /> Sample app arance: Look: <br /> Equipment reply- (check all that apply) Note condition of replaced item <br /> 2" Lacking Cal I' _ Look #3753 : 7/32 Allenhead: <br /> 4" Lacking caj7 __ Look-Dolphin:_ 9/16 Bolt: <br /> 6" Locking cape Pinned Allenhead (DWP) : <br /> iJ ' I-Z4 Of <br /> r <br /> Signature: �-�--- <br />