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DOULOS ENVIRONMENTAL COMPANY SdMMMWKf INFORMATION SHEET <br /> Client: Sampling Date: - '� <br /> Site : ,,I-/ 60 _ Project No <br /> 46,!]41a,, Well Designation: ZJ <br /> ell <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? 9 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" UV 1211 UV 12" tMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI ther_/Z <br /> General condition of wellhead assembly: Excellent oo 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" y 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft . <br /> Initial Measurement Recharae Measurement <br /> Time. / S-06 Time: M L1 Calculated purge. <br /> Depth of well . d Depth to water: z,6,3 D Actual purge : L44 1 h <br /> Depth to water:_iLL) m <br /> Start purge : _ � L� Sampling time: � t� <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance- / Lock: r <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 /> Signature - 1)/-av/wl _oor_�� <br />