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DOULOs ENVIRONMENTAL, COMPANY SJMEPMI�-b INFORMATION SHEET <br /> C11ent: Sampling Date:_ ��`Oc'-> <br /> Site ' _ - - �-.1 6 --• Project No. : <br /> Well Designation: /q w-7 <br /> v <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? R 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) : <br /> Well cover type : 8"' UV > 1211 UV 121�_ EMCO 81" BK <br /> 12" BK 12" DWP 12 '" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent CG o o_J 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'" .��. 4" 6"' g" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> initial Measurement Recharge Measurement <br /> Time: Time: sic.42 Calculated purge :-&. �,r« <br /> Depth of we 1 Depth to water:_ � _� Actual purge <br /> Depth to water:L9.L6• <br /> start purge :. )- 03S Sampling time: )_d 4�S <br /> Time Temp. E.C. pH Turbidity Volume <br /> �b 3 7 70 <br /> 70-3 �-- �- <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 /> 6" Locking Cap: Pinned Allenhead (DWP) . <br /> Remarks : <br /> Signature / <br />