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DOULOS ENVIRONMENTAL COISPANYINOMOMINFORMATION SHEET <br /> Client: r-C- Sampling Date:_�271- 06 <br /> Site : A V-cu 4-, - q(09 Project No. <br /> 1S + O Well Designation:17 1 11 <br /> oc� CA. <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? 2 YES Above TOC Below TOC <br /> Is top of casing cut level? No 1 If no, see remarks <br /> Is well cap sealed and locked? NO y`F:40 If no, see remarks <br /> Height of well casing riser (in inches) ': *3qI <br /> Well cover type: 8" W 1211 UV 12" EMCO 8" SK <br /> 12" BK 1211 DWP 1211 CNI 3 611 CNI other t •'/Y�-b <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4T1 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 4104 611 gn <br /> Purge Vol . Multiplier : 0 . 16 0. 65 3.. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: -/ 6 rf� Time: Calculated purge: ��� <br /> Depth of well : 5 11 L41 Depth to water: /* Actual purge: <br /> Depth to water:_-jCjC-a <br /> Start purge: Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> L17 or <br /> joq <br /> / 744 <br /> Sample appearance: 14 Lack: <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 /> 61' Locking Cap; Pinned Allenhead (DWP) :' <br /> Remarks : <br /> Signature: <br />