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10/05/2000 05 35 9167829054 DOULDS PAGE 06 <br /> DOULC)S ENVIRONMENTAL COMPANY +AUMPMV# INFORMATION SHEET <br /> Client: sampling Date: IL-L4120 <br /> Site __.- Project No. <br /> Well Designation: <br /> Is setup of traf ir- control devices required? YES time: hours <br /> Is there standing water in well box? JW Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: S" UV 12" W X2" EMCO _ $" SK <br /> 12" BK l2" D'WP 12" CNZ 36" CNI �ther ' <br /> General conditio rtf wellhead assembly: Excellent 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: Teflon bailer: <br /> Well Dia:4eter: 2" 4" 6" 8+'__,.__ <br /> Purge Vol. Multilier: 0. 16 0. 65 1.47 2 .51 gal/ft. <br /> initial Meeis, t <br /> Time:_U�t tl Time: 11A Calculated purge: ~�- ' <br /> Depth of well: al Depth to wa er: Actual purge: 22 0 9 <br /> Depth to water: -i T <br /> Start purge: �', Sampling time: <br /> Time emp. E.C, pH Turbidity Volume <br /> Wo `f <br /> Sample appearance: Lock: <br /> Equipment replace] (check all that apply) Note condition of replaced item <br /> 2" Locking Cap: 1Look 03753 : 7/32 Allenhead: _ <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Lockinq Cap, T, - Pinned Allenhead (DWP) : <br /> . Remarks; <br /> Signature: <br />