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DOULOS ENVIRONMENTAL COMPANY INFORMATII01"N �S�HEET <br /> Client: f}'fiy� .�.� Sampling Date: <br /> Site. ,1_J 61e Project No. : <br /> �41gWell Designation: w,1 <br /> Is setup of traffic control devices required? YES time, hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" W 12" W 12" EMCO 8" B <br /> 12" BK 12 " DWP 12" CNI 36" CNI 600t <br /> here- <br /> General condition of 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: .�c< <br /> uuruno.rr�.n .r ern rnrrrr <br /> Well Diameter: 2" Y 1 41' 6" 8" <br /> ,Purge Vol . Multiplier: 0.116 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement, Recharge Measurement <br /> Time: Time: _J.601 Calculated purge: z <br /> Depth of well : ?I CXR Depth to water: .2-- 3,3 lG Actual purge - 2 IS b � <br /> Depth to water:_?-_/r lS <br /> Start purge : /S 45 Sampling time: 01- <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1549 7 0- Zf <br /> ISS / 910 �. - r4v 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead• <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt * <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature <br />