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DOUL08 ENVIRONMENTAL COMPANY ,fig INFORMATION SHEET <br /> Client : N_�__C_N Sampling Date: <br /> Site ►I' Cr � l Project <br /> No <br /> 13 'i �30 o Well Designation: 3 <br /> Is setup Of traffic control devices required? YES time: hours <br /> Is there standing water in well box? <U YES Above TOG Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? <br /> NO E If no, see remarks <br /> Height of well casing riser (in inches) : _ ? <br /> well cover type: 8" W 1211 UV 1211 MCp 8 11 BK <br /> 1211 BK 1211 DWP 12" CNI_ 36" CNI Other..12--m 7i <br /> General condition of wellhead assembly: Excellent oa Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 419 . 611 811 <br /> Purge Vol . }4fultiplier: 0 . 1.6 0165 1. 47 2 . 61 gal/ft . <br /> -Initial Measurement Recharcre Measurement <br /> Time: J Time: Calculated purge: 4' 1-2.Depth of well 1, 11 Depth to water: 'AIA Actual purge <br /> Depth to water: 3 uZ <br /> Start purge: Sampling time: 2O _l� <br /> W--r7Temp. E. C. pH Turbidity Volume <br /> 7C, r <br /> Sample appearance; � .s� Lock: f <br /> J <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking cap; Lock , 3753 : <br /> 4" Locking Cap:_ ---- 7/32 Allenhead: <br /> Lock--Dolphin: 9/16 Bolt:� <br /> 6" Locking Cap: Pinned Allenhead (DWP) ; <br /> Remarks : <br /> Signature: .�- <br />