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I <br /> DOOLOS ENVIRONMENTAL COMPANY INFORMATION SHEET <br /> i Client: Sampling Date: r Y— dot <br /> I Site: Project No. : <br /> PQun Ad Well Designation: e4l <br /> /—.a to r�,a , 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? 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) : f <br /> well cover type: 8" UV 12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 1211 CNI 36" CNI Other_&!'V Je f_S <br /> General condition of wellhead assembly: Excellent ® Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> I 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 /> OInitial Measur2Ment RechAgagMeasurement <br /> Time: .1 = S O_ Time: <br /> Calculated purge : <br /> Depth of well : X8. 7 Depth to water: Actual purge : <br /> Depth to water: , <br /> Start purge: / Sampling time: <br /> ITime Temp. . E.C. PH Turbidity Volume <br /> VOL <br /> I <br /> 4 •� t / o -7- 06 ----- l 2 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> I 6" Locking Cap: Pinned Allenhead (DWP) ; <br /> Remarks: <br /> I <br /> Signature: <br />