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Scop <br /> DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> • Client: `i .�ii Sampling Date: ` <br /> Project No. : <br /> Well Designation: <br /> Is setup of traffic control devices required? N YES time- hours <br /> Is there standing water in well box? S 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" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNIher <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailer -Y Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer x <br /> Well Diameter: 2" 4" 619 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement RechgKRe Ileasurement <br /> Time: f6()�t Time: Calculated purge: <br /> Depth f well * �-T 65 Depth to water: Actual purge . fj <br /> Depth to water: 2-0,X7­ <br /> Start purge,._ Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> / 5a� ? � 2 <br /> 7/ <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 /> 41" Locking Cap: Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap- Pinned Allenhead (DWP) : <br /> Remarks : <br /> t <br /> Signature : 1 <br />