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DOULOS ENVIRONMENTAL COMPANY S INFORMATION SHEET <br /> Client: ,n,�� �,lj„ _ Sampling Date: <br /> Site _ - .] �_ Project No. : <br /> Well Designation: <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? g'E If no, see remarks <br /> Is well cap sealed and locked? NO YL If no, see remarks <br /> Height of well casing riser (in inches) - <br /> Well cover type : 811 W 12f1 W 1211 EMCO 811 BK <br /> 1211 BK 1211 DWP 1211 CNI 3 611 CNI Other <br /> General condition of wellhead assembly: Excellent (:�_oo d Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4t1 PVC bailer N Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 411 6T1 811 <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time : 4,4 Time : , )-A Calculated purge <br /> Depth of well : 3CO Depth to water: Actual purge r, <br />' Depth to water: /,P 7,1 <br /> 3 <br />`r <br /> Start purge: Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> I <br /> i <br /> 6 S 6 <br /> Sample appearance : w _ Lock: y?L <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 /> i <br /> Signature � �- <br />