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t DOULOS ENVIRONMENTAL 'OKPANY S ! LING INFORMATION <br /> SHEET <br /> Client: Sampling Date: l--7 1� <br /> Site• A-e to- 3 1461 &1v a,, Project NO. : <br /> Well Designation: JI V.-"-! <br /> Is setup of traffic control devices required? NO�: YES time: hours <br /> Is there standing water in well box? NO' S Above TOC below TOC <br /> Is top of casing cut level? NO t4 If no, see remarks <br /> Is well cap sealed and locked? NO �Egj If no, see remarks <br /> Height of well casing riser (in inches) : -� <br /> Well cover type: 8" UV 12" UV_ Y— 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good 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: Disposal bailer Teflon bailer: <br /> Well Diameter: 211� 41e 6n g <br /> Purge Vol. Multiplier: 0.16 0. 65 1.47 2 . 61 gal/ft. ` <br /> Initial Measurement Recharge Measurement <br /> Time:_ xz.0 Time:7 A Calculated purge:_L� r.••s! <br /> -Depth of well: 741.5/ Depth to water:, 1,b �> Actual purge: s� <br /> C)epth to water: 61.3U <br /> Start purge: '�40 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: Cl!-_ � 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 /> i <br />