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DOULOS ENVIRONMENTAL COMPANY S INFORMATION SHEET <br /> Client: <br /> Sampling Date: <br /> Site . Project No. : <br /> r � 1 �A#C^43,-IiZ,, Well Designation: M!q,�L' <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 U�lIf no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 1211 UV 1211 EMCO 8"" BK <br /> 1211 BK 12" DWP 1211 CNI 36" CNI ther J/)"1 )'P 1 <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer _ _Submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with- Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 411 611 811 <br /> i <br /> Purge Vol . Multiplier: 0 , 16 0 . 65 1. 47 2 61. gal/ft <br /> Initial Measurement Recharcre Measurement <br /> Time -- IL4je„ Time: ,(9[4t . _ Calculated purge:-60,i- <br /> Depth <br /> urge; 60,ZDepth of well : 3 LiT Depth to water: Actual purge 60,2-) <br /> Depth to water: <br /> I <br /> start purge: /6 3b Sampling time: 1644 <br /> I <br /> Time Temp. E. C. pH Turbidity Volume <br /> /63 ?1,3 4f- 73 / <br /> /640 '20- 2- X1)0 -7 <br /> jV �-, <br /> 16 4S 70,3 qO 71CI 3 <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 /> 61" Locking Cap : Pinned Allenhead (DWP) • <br />• Remarks , <br /> Signature : <br />