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DOULOs ENVxRONMENTAL COMPANY faJONIM& INFORMATION SHEET <br /> Client: rC. Sampling Date: s_z1_ op <br /> Site : lrc `�� Project No. : <br /> Vi _ Well Designation; Mill ` 6 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO !�,n If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) ; +q <br /> Well cover type : 8" UV 12" UV 12" EMCO 8" BK <br /> 12 " BK 12 " DWP 12" CNI 36" CNI Other lZ'iY1� <br /> 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 bailer Centrifugal pump <br /> Sampled with: Disposable bailer:-- Teflon bailer: <br /> Well Diameter: 2" 411 `l 61' 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/£t. <br /> Initial Measurement Recharcre Measurement J ' � <br /> Time: Time: Calculated purge: 4 .S <br /> Depth of well : Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge: ' 17/(2 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 17�o Z 52L 73� <br /> Sample appearance: Lock: rAn <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 /> ell <br /> Signature: <br />