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DOULOS ENVIRONMENTAL COMPANY Srd INFORMATION SHEET <br /> Client: �,�d, Sampling Date:_ <br /> Site Project No. : M <br /> Well Designation- <br /> Is <br /> esignation•Is setup of traffic control devices required O YES time* hours <br /> Is there standing water in well box? 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 fE If no, see remarks <br /> Height of well casing riser (in inches) - <br /> Well cover type : 8" UV 12" UV 12" EMCO 8" BK <br /> 12 " BK 12" DWP 12" CNI 36" CNI Other '(?),i/J <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 bailercentrifugalpump <br /> Sampled with : Disposable bailer: Teflon bailer. <br /> Well Diameter: 2" 4" 6" S" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement echa e Measurement <br /> Time: ti t-1 u Time : Calculated purge: z� <br /> Depth of well . Depth to wa er: Actual purge <br /> Depth to water: � S z <br /> Start purge:_ /0 Sampling time: /f <br /> Time Temp. E. C. pH Turbidity Volume <br /> r r - <br /> !4D <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: 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks : t <br /> Signature: 'may <br />