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08/1612000 08 24 9167829054 DOULOS PAGE 04 <br /> DODLOS ENVIRONMENTAL COXVAM joop� INFORMATION SHEET <br /> Client.A-rC, Sampling Date: <br /> Site. ArcC-�- (9010 ^� Protect No. <br /> bV1s e We11 Designation: W <br /> 2 LL <br /> Is setup of traffic control devices required? No YES time; hours <br /> Is there standing water in well box? NO YES Above TOC Below TOC <br /> Is top of casing cut level? No YES If no, see remarks <br /> Is well cap sealed and locked? No YES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type 8" LTV_ 12" UV,_ 12" EMCO 8" E <br /> 12" $K 1 ?" DWP _-- 1210 CNY 36" CNI ot erL2-"Aj-+jj -- <br /> General condi* • of wellhead assembly: Excellent ood Fair Poor <br /> Purging Equi <br />