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DOULOS ENVIRONMENT: COMPANY . �PLING INFORMATION SHEET <br /> Client: U tra ar Sampling Date:-,.e?-3�r <br /> Site: Beacon 474 Project No. :- 94-474-01 <br /> 3440 E. Main Street Well Designation: <br /> Stock on CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? �9YES Above TOC Below-TOC <br /> Is top of casing cut level? NO 1M;� If no, see remarks <br /> Is well cap sealed and locked? NO, JIM> If no, see remarks <br /> Height of well casing riser (in inches) : - <br /> Well cover type: 8" UV_ 12" UV12" EMCO 8 h BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other /2 � d <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer X Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2"-Y11- 4" 6" all- <br /> Purge <br /> "Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> initial Measurement_ Re&harge Measurement <br /> Time: 10 ' ;U' Time: Calculated purge: f <br /> Depth of well: Depth to water: Actual purge* ^ <br /> Depth to water: - <br /> Start purge:_ y :0 O_ Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <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: <br /> Signature: <br />