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10/05/2000 05 35 9167829054 DOULOS PAGE 04 <br /> MULOS ENVI ONMENTAL CONPANY INFORMATION SHEET <br /> Client: Sampling Date: `e?� � �`�G <br /> Site: Project No. : <br /> Well Designation: <br /> Is setup of traffic control devices required? fJ YES time: hours <br /> Is there stand water in well box? YES Above TOC Below TOC <br /> Is tap of c�si. g cut level? iV TTq If no, see remarks <br /> Is wall cap se led and locked? NO If no, see remarks <br /> Height of well Icasing riser (in inches) : 3 <br /> Well cover typ . 8" UV 12" W 12" EMCO 8" BK__$___ <br /> 12" BK 1- " DWP 12" CNY 36" CNI_ Other <br /> General condition of wellhead assembly: Excellent qZFair Poor <br /> Purging Equipzn(i1 - 210 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled w, h Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> 0 Initial 00'% sff,&ft� <br /> Purge Vol. Multi plier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Time: 'Time <br /> Calculated purge; -it <br /> Depth of well L Depth to water: Actual purge: _ <br /> Depth to water: <br /> Start purge: ' 't ' Sampling time: AIL <br /> Time Temp. E.C. pH Turbidity Volume <br /> l o t µ 40 <br /> Sample app arance: Lack: <br /> Equipment replac-ed: (Check all that apply) Note condition of replaced item <br /> 2" Locking Ca : Lock 03753: 7/32 Allenhead: <br /> 4" Locking Cal :_�� Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking call _ Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature. /�� <br />