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DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: -fn�"W _ Sampling Date: <br /> Site :___ _ � 6 Project No. : <br /> JJ,J <br /> ok Well Designation: W- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 19 Y S 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) : - <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP12" CNI 36" CNI ther <br /> General condition of ellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 21" PVC bailer Dedicated bailer <br /> 4" PVC bailer ^Centrifugal pump <br /> Sampled with- Disposable bailer: Teflon bailer: X `' <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. . Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> initial Measurement Recharge -Measurement <br /> Time: ''fD Time: Calculated purge: .6 <br /> Depth of well : 511. Depth to water: � /Cf41- Actual purge . 64 6 <br /> Depth to water• 26 QJ-- <br /> Start purge: 1S 10 Sampling time: D <br /> Time Temp. E.C. pH Turbidity Volume <br /> uo <br /> Sample appearance: ✓ 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 />