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� ��"' <br /> DOULOS ENVIRONMENTAL COMPANY INFORMATI N EE`s <br /> Client: tned' r.� Sampling Date: <br /> Site: Project No. : <br /> Well Designation: / 4w, 7 <br /> G r4 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 19 YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked-7 NO 43 if no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" UV "C 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 211 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: 2111)� 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time• Time: )L_0U'7 Calculated purge:�� <br /> Depth of well: t Depth to water: 20.3 Actual purge: <br /> Depth to water: to6 <br /> Start purge : Z O 3 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> a.a 3-7 70 (F r 1 <br /> 70.3 y- ;-Q 6 qO 2` <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 /> 61" Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks . ' <br /> ,J <br /> Signature: <br />