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DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Alg:�= Project No. : <br /> 1 <br /> 3'6 oa S. POP-16411 /QAC Well Designation: Miw r <br /> L <br /> 4 _ <br /> y,a <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? QJ� 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" UV12" UV12" EMCO 8" HK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other t <br /> 1 General condition of wellhead assembly: Excellent @60 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer .Centrifugal pump <br /> 1 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 /> 1Aftnitial tleaslAx:ements e <br /> MW ime: 2&d Time; Calculated purge: <br /> Depth of well : �' 3 Depth to water: , Actual purge :�_� <br /> Depth to water: - <br /> Start purge: W,Z}_. Sampling time: N <br /> 1 Time Temp. . E. C. pH Turbidity Volume <br /> UD L 1 `1 3, tj f0 L/ <br /> 1 <br /> 1 Sample appearance: Lock: /V <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: 9/36 Bolt: <br /> 1 6" Locking Cap: Pinned Allenhead (DWP) : <br /> IsRemarkss <br /> I <br /> Signature : <br />