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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> Client (Ag—co 1 Sampling Date:__=_2 7_ 6->0 <br />• Site b Pro3ect No . : <br /> Well Designation:-CE ,�� <br /> OC 0A-" C /-I 4t <br /> Is setup of traffic control devices required? YES time • hours <br /> Is there standing water in well box? 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" UV12" W 12" EMCO 8" BK <br /> 12 " BK 12 " DWP 12" CNI 36" CNI Other in-i <br /> General condition of wellhead assembly: Excellent 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" 8fi <br /> Purge Vol . Multiplier: 0 16 0 . 65 1 , 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time . 7 3 S Time: ( 3 Calculated purge . �� <br /> Depth of well : Depth to water: 4/ � 2o Actual purge - O <br /> Depth to water, <br /> Start purge :__ Sampling time: � 0 3 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1-157f 0 <br /> j cl <br /> a 2 t-Z , o ..�.- <br /> Sample appearance - Lock : All 14 C <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: sock #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 />