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Ayq <br /> DOULOS ENVIRONMENTAL COMPANY r INFORMATION� SHEET <br /> Client: Sampling Date: ? -30-60 <br /> Site- Project No. <br /> Well Designation:N1 UV S <br /> Is setup of traffic control devices required? YES time- hours <br /> Is there standing water in well box? X 45 Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : J <br /> Well cover type: 8" W 12" LN 12" EMCO 8" BY <br /> 12" BK 12" DWP 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: ExcellentGoo 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:__V Teflon bailer: <br /> Well Diameter: 211 4" 6" 8" <br /> Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft <br /> .Purge <br /> I tial Measurement geche Measurement <br /> Time: Time: Calculated purge: <br /> Depth of well -AD-6n - Depth to water: Z Actual purge . 6 if; <br /> Depth to water: <br /> Start purge: JV )-5- _. _ Sampling time <br /> Time Temp. E. C. pH Turbidity Volume <br /> 431 �Lj <br /> 7C� / L <br /> Sample appearance: Lock: t <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: - <br /> Ile <br /> Signature: <br />