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DOULos ENVIRONMENTAL COMPANY S INFORMATION SHEET <br /> Client : Sampling Date: <br /> Site •_ / Project No. : <br /> 1 ��.• �Glw.r Well Designation: <br /> Is setup of traffic control devices required? b YES time: hours <br /> Is there standing water in well box? YES 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) * t <br /> Well cover type : 8" UV 12" UV 12'w EMCO 8" B <br /> 12 " BK 12" DWP 12" CNI 36" CNI her <br /> General condition of wellhead assembly: Excellent oad 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" 4v' '� 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: 17,'/ Calculated purge: �. 9 <br /> Depth of well . fi�t,��3 Depth to water : .3_ Actual purge y ! <br /> Depth to water: 1 �-q <br /> Start purge: J730 Sampling time: /75 .'21 <br /> Time Temp, E.C. pH Turbidity Volume <br /> 1 ) 73'71 70V- 2-;7 5 Ap <br /> 2-7U0 -2 <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 : , <br />