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1 <br /> DOULOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Project No. : <br /> rV <br /> 1 <br /> 1401-Ian Rd well Designation; M ui© ~' <br /> Leri-A , GA - 0 <br /> 1 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? 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" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> 1 Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 1166 0. 65 1. 47 2 , 61 gal/ft <br /> 1Aknitial Ifeag men Recharge Measurement <br /> NOPtime : " Time% w Ar Calculated purge: <br /> Depth of well : 1z Depth Depth to water: Ao" Actual purge, r <br /> Depth to water: :2- <br /> Start purge: N A--' Sampling time: <br /> 1 Zv— <br /> Time Temp. , E. C. pH Turbidity Volume <br /> Uo L ( C I -7- 0 �? <br /> 1 <br /> to <br /> Sample <br /> � . <br /> I Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 21' Locking Cap: Lock 13753 : 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 />