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DOUL0S ENVIRONMENTAL COMPANY S INFORMATION SHEET <br /> C1lent. ,�d,�� � Sampling Date: 00 <br /> Site : ,�-1, 6 Q _ _ Project No. <br /> 44L QWell Designation: /q iA/' I C <br /> Is setup of traffic control devices required? YES time - hours <br /> Is there standing water in well box? 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" W 12" UV 12" EMCO 81" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI her/� ) if' _ <br /> General condition of wellhead assembly. Excellent aLO 01 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with - Disposable bailer: Teflon bailer- <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft <br /> s � <br /> Initial Measurement Recharae Measurement <br /> Time: N Time: 1 ; ,, f n Calculated purge • '� ' <br /> Depth of well:_ D� Depth t6 water: fF "I Actual purge <br /> Depth to water : fjr,�J <br /> # <br /> Startpurge: D Sampling time: <br /> F <br /> Tem� <br /> Time p. E. C. pH Turbidity Volume <br /> i <br /> 456 )- 71 I <br /> 7c7, Ll- r o <br /> 63 3 <br /> Sample appearance:r rr Lick: <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 . r-''�� -� E r /6 27 <br /> S zgnature • <br />