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DOUL08 ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: �-36"00 <br /> site : Project No. : <br /> Well Designation: MW-1C_ <br /> Is setup of traffic control devices required? N YES time- hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? 2 <br /> '�S If no, see remarks <br /> Is well cap sealed and locked? NO If no , see remarks <br /> Height of well casing riser (in inches) : 13 <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI her <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: " <br /> Well Diameter: 211-4— 4" 6" 8+1 <br /> Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> ,Purge <br /> I tial Measurement Recharge Measurement <br /> Time: IU.?a Time: � Calculated purge : .�� <br /> Depth of well : 06-co Depth to water: �- / Actual purge. 6 �� <br /> il <br /> Depth to water: <br /> Start purge: 16 Q? Sampling time: Z62_ 5 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 16 13- 7/, ;;- <br /> 16f-6 90-V- <br /> 6 <br /> 0- y6 S3 10 <br /> Sample appearance: a'- ,� Lock: R� <br /> • Ii1•I I I•lill <br /> •• run r�r <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 : 0 0, 37 <br /> Signature: =� <br />