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DOULOS ENVIRONMENTAL COMPANY SAINNERf INFORMATION SHEET <br /> Client: Sampling Date• <br /> Site Project No. : <br /> Well Designation: W- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 19 )_S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12 " BK 12 " DWP12" CNI 36" CNI Other <br /> General condition of ellhead assembly: Excellent (C'00i 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: k �� <br /> Well Diameter. 2" 411 6" 8" <br /> . Purge Vol . Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft <br /> Initial Measurement echa a easurement <br /> Time: I4 b Time: 164 _ Calculated purge: .b <br /> Depth of well : S b, p 7 Depth to water; __� /, if 64- Actual purge 544 6 4 <br /> Depth to water: 2-D-gj-- <br /> Start purge; IS 20 Sampling time: .'ri LiAO <br /> Time Temp. E. C. pH Turbidity Volume <br /> X71 <br /> Sample appearance: Lock: <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 /> Signature . Q-�'� <br />