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i <br /> DOULOS ENVIROMMAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Project No. : <br /> Well Designation: NI � L <br /> L <br /> Is setup of traffic control devices required? � YES time: hours <br /> r 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) : 4-FC) <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other 0 <br /> r General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer —Centrifugal pump <br /> r Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2'r-41 49 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft . <br /> rAftnitial MeAggrementRechargeMeasurement <br /> ime: 2: L O _ Time: ti Calculated purge: <br /> Depth of well; 2 6 Depth to water; ar Actual purge* <br /> Depth to water: <br /> Start purge: A- Sampling time:_,✓ !q- <br /> 1 <br /> Time Temp. , E.C. pH Turbidity Volume <br /> -7rcl 105 <br /> r <br /> vp L 1040 1 • ot. <br /> r 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 /> 411 Locking Cap: Lock--Dolphin: 9/16 Bolt . <br /> r 6" Locking Cap: Pinned Allenhead (DWP) : <br /> *Remarks : <br /> r Signature : <br />