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DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: 00 <br /> Site: Project No. : <br /> Z4 1 CZ ���.00, da _ Well Designation: W3 <br /> Is setup of traffic control devices required? q@ YES tine : hours <br /> Is there standing water in well box? YES 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}l W 12" W T12" EMCO 8" HK <br /> 12" BK 121" DWP)_ 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent M_ Fair Fair Poor <br /> t <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 Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> OInitial Measurement_ Recharge Measurement a <br /> Time: I3— Time: Calculated purge : �6"1"r_/ <br /> Depth of well: S Depth to water: 1 / 39 Actual purge : <br /> Depth to water: <br /> Start purge : I S Sampling time: / 7cZ,O <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7YJ <br /> 2,3 6 4 71("5 3 <br /> Sample appearance:,. , ,.I Lock: rZL' — <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 /> f <br /> 1101 <br /> Signature: <br />