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" 11 SAD ANG INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL ..OKPANY <br /> Client: Ultra]Da <br /> Sampling Date: q ' _q <br /> Site: Beacon Project No. : - <br /> 23 0 �- Well Designation: MW <br /> a -� <br /> Stockto CA <br /> hours <br /> Is setup of traffic control devicesrequired? YES Above.TOC Below TOC <br /> Is there standing water in well box.' NO S If no, see remarks <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? <br /> Height of well casing riser (in inches) : 121+ EMCO 8" BK—_— <br /> Well cover type: 8" UV 12„ I�^� 36" CHI her <br /> 12" BF-- . 12" DWP— Excellent oo Fair Poor <br /> General condition of wellhead assembly: <br /> submersible pump <br /> purging Equipment: 2" disposable bailer Dedicated bailer <br /> +�211 PVC bailer Centrifugal pump <br /> 411 PVC bailer --�- <br /> Sampled with: Disposable bailer:__ <br /> Teflon bailer:. <br /> Well Diameter: 2" 4 <br /> 0.65 1.47 2. 61 gal/ft.qe Vol. Multiplier: 0. 16 Measurement_ <br /> e Calculated purge: 9 6 <br /> Time: Time: g Actual purge: !6 <br /> Depth of well: Z Depth to water: <br /> Depth to water L4 + <br /> Start purge: 3 sampling time: �f - <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> L*7 a, 1 i .z 762- <br /> 761 <br /> 62- <br /> - <br /> 3� <br /> 61, 3 10 u f 75 3 <br /> y' -7" I0 3z 75J <br /> -J--- <br /> Sample appearance: cle � Lock: ��-- <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock x'3753:_ 7/32 Allenhead:,� <br /> g P• r Lock-Dolphin: 9/16 Bolt:,._ <br /> 4" Locking Cap: <br /> Locking cap: Pinned Allenhead (DWP) :�.�. <br /> " <br /> Remarks: <br /> R.`�rrrsi »ra• �p -- - - - <br />