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08/16/2000 08 24 9167829054 pOULOS PAGE 03 <br /> DOUL08 ENVIRONMENTAL COMPANY S fG INFORMATION SHEET <br /> Client 4rc! Sampling Date: 6 00 <br /> Site. (bceV Project No <br /> well. Designation: zqw J <br /> LAI <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there 8tanCi ng water in well. box? YES Above TOC Below TOC <br /> Is top of CaSLrg cut level? qZM If no, see remarks <br /> Is well cava sealed and locked? � YR9 If no, see remarks <br /> Height of well casing riser (in inches) ': <br /> Well cover type : e" LV 1211 W 121' EMCO_ 811 BK <br /> 12" BK 12" DWP 12" GNI_36" CNZother/1 t!!J4 <br /> General cond.,+ n of wellhead assembly: Excellent oo Fair Poor <br /> Purging EquipT-?- f- 2" disposable bailer Submersible pump <br /> 20' PVC bailer _Dedicated bailer <br /> 4" PVC bailer �.. Centrifugal pump <br /> Sampled with: Disposable bailer:� Teflon bailer: <br /> umu_- <br /> Well E ?meter: 211 4n 611 811 <br /> Purge Vol . Multiplier: 0. 16 0. 65 1 .47 2 . 61 gal/ft. <br /> InitiglXegsurTp n Recharcy XeasureM2nt <br /> Time: Tine:- <br /> Calculated purge: L <br /> Depth of well Depth to water: Actual purge: <br /> Depth to water ,_ <br /> Start purger n ' fi1 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> x-701 7, �I <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 Lack-Dolphin: 9/16 Bolt;� <br /> 6" Locking Cap: Pinned Allenhead (DWP) .� <br /> . Remarks: <br /> Signature: � J <br />