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DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Aft !-,,, _... ._.._ Sampling Date: `� D <br /> Site: � Project No. : <br /> ot'n Well Designation: MVJ <br /> C' <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 2 Y 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 E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : ST' W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNY 36" CNI Other ll-'M- n <br /> General condition of wellhead assembly: Excellent Goo 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« A 411 611 8r1 <br /> $� Purge Vol . Multiplier: 0 . 16 0. 65 1, 47 2 . 61 gal/ft <br /> initial Measurement ech e Measurement <br /> Time : u30 Time: Calculated purge : 1 �i <br /> 1 Depth of well : Depth to water: LA Actual purge : S��Z <br /> Depth to water• <br /> Start purge: ` Sampling time: <br /> s <br /> i Time Temp. E. C. pH Turbidity Volume <br /> Li 00 <br /> f711 <br /> sle <br /> Sample appearance: r 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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> J <br /> Signature. <br />