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DOUL08 ENVIRONMENTAL COMPANY SAUNNUf INFORMATION SHEET <br /> Client: � � Sampling Date:-f-so-or <br /> _ <br /> Site:_ ,�-/ 6 e Project No. :. ..---- - r <br /> LX Well Designation: M�IV `{ <br /> r: G A <br /> Is setup of traffic control devices required? NO <� time hours <br /> Is there standing water in well box? ALO Above TOC Below TOC <br /> Is top of casing cut level? NO If 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 12" W 12" EMCO 8" BK <br /> 12 " BK 12" DWP 12" CNI 36" CNI --other <br /> General condition of wellhead assembly: Excellent ku-04 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 /> rri irir ii irinn — ..mnn..r <br /> Well Diameter: 2" y4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharcre easurement <br /> Time : l !1Time: L zOt Calculated purge. / d <br /> Depth of well : 1-9 Depth to water: LD Actual purge <br /> Depth to water: 10,11- <br /> Start purge : rP--OZ Sampling time: 2J830 <br /> Time Temp. E. C. pH Turbidity Volume <br /> d ' 9360 .� <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />