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DOULOB ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: .21 6 _ Project No. l,,' <br /> Well Designation: VV _ <br /> -- irA <br /> Is setup of traffic control devices required? O YES time: 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 15 If no , see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12'w EMCO 8" B <br /> 12" BK 12 " DWP 12" CNI 36" CNI her <br /> General condition of wellhead assembly: Excellent Lood 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 Diameter: 2" 411- 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: 175/ Calculated purge: 0. � <br /> Depth of well : 5�,�3 Depth to water: - 3 k Actual purge : 71 fl <br /> Depth to water: .2- 14M <br /> Start purge: .-1-7-3.0 Sampling time:__�7J ___ <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Look #3753 : 7/32 Allenhead • <br /> 4" Locking Cap: Lock-Dolphin: 9/1.6 Bolt * <br /> 6" Locking Cap: Pinned Allenhead (DWP) . <br /> Remarks : <br /> Signature . <br />