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10/05/2000 05 35 9167029054 DOULOS PAGE 03 <br /> • DOULOS ENVI OMBNTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: 2�1 �4� <br /> site*. Project No. : <br /> C, OL41. Well Designation: L41 -IM-1C <br /> Ips setup of traffic control devices required? YES time- hours <br /> Is there stand ng water in well box? In YES Above TOC Below TOC <br /> Is top of casing cut level? Nb T If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type . all UV 12" UV12" EMCO 8" BK <br /> 12" BK 1 . 11 DWP 12" CNI 36" CNIher,��-�-� <br /> General condit on of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipm4ir4- 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled Wath Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" $" <br /> T <br /> . Purge Vol. Mul iplier: 0. 16 0. 65 1. 47 2. 61 gal/ft. <br /> Initial Measure ent <br /> Time: I k 1 S — Time: t Calculated purge: �T� <br /> Depth of well:_ Depth t water: 1 ' _ Actual purge:,,7Z_ <br /> Depth to water: d <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> f <br /> Sample appearance: Lock: <br /> Equipment repla eco ; (Check all that apply) Note condition of replaced item <br /> 211 Locking Ca Lock 13753: 7/32 Allenhead;�,._,�____ <br /> 4" Locking Ca Lock-Dolphin: 9/16 Solt: <br /> 6" Locking Cad _ Pinned Allenhead (DWP) : <br /> Signature. W r <br />