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DOULOS ENVIRONMEN'T'AL COMPANY SNOMW INFORMATION SHEET <br /> Client : Sampling Date: 00_ 3Q <br /> Site -- / �1� _ _ Project No . : � t�, <br /> Well Designation: m)� CB <br /> O � <br /> Is setup of traffic control devices required? (-N'b YES time: hours <br /> Is there standing water in well box? W US Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO YU If no, see remarks <br /> Height of well casing riser (in inches) : A <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 1211 BK 1211 DWP 1211 CNI - 3611 CNI her <br /> m <br /> General condition of wellhead assembly. Excellent Goo 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" 11L 4" 6" $" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft . <br /> rInitial Measurement Becharge Measurement , <br /> Time. _I To L}- Time: 13 Calculated purge, <br /> Depth f wewell , Depth to water: �- Actual :ur e `� <br /> Depth to water: 2-0,2,-7 p g 9 <br /> Start purge: Sampling time: L� <br /> Time Temp. E. C. pH Turbidity Volume <br /> M /Sc X36 <br /> �Iq4q 12 1, Oq W <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 /> r <br /> r <br /> f <br /> Signature r'� <br />