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DOULOS ENVIRONMENTAL COMPANY SAIMMOKFb INFORMATION SHEET <br /> Client . Sampling Date: <br /> Site: Project No. : <br /> A4, 4n,la—'_'_ Well Designation: <br /> G A <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's NO If no, see remarks <br /> Is well cap sealed and locked? NO YtS If no, see remarks <br /> Height of well casing riser (in inches) . '5 <br /> Well cover type : 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12 " CNI 36" CNI Other/ 1"YA <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" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft . <br /> Initia4 Measurement Recharge Measurement <br /> Time: _4}- Time: 414 Calculated purge : <br /> Depth of well : Depth to water: Actual purge. 1 <br /> Depth to water:?-�6-76 <br /> Start purge: 716 Sampling time: - <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7 6. <br /> `I 51 (/ "CI <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 /> 4 " Locking Cap: Lock-Dolphin: �4 9/16 Bolt ' <br /> 6" Locking Cap: Pinned Allenhead (DWP) . <br /> t <br /> Remarks . � �r r �_6 5 � r 4 -� 1. T, .` < _Z' <br /> signature : <br /> VI _ <br /> L <br />