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Sample appearance Lock <br />Equipment replaced (check all that apply) Note condition of replaced item(s) <br />2" Loclang Cap Lock 7/32 Allenhead. <br />4" Locking Cap Lock -Dolphin, 9/16 Bolt, <br />6" Locking Cap pinned Allenhead (DWP) <br />Remarks <br />• <br />'Signature, <br />- - <br />SAMPLW INFORMATION SHEET <br />Client Ramage Erivironmental <br />Sampling Date <br />Site Stockton Metre Aixport <br />Project No , <br />5000 $ Airport Way Well Designation <br />Stockton, CA <br />Is setup of traffic controldevices required? YES <br />Is there staudmg water in the well box9 YES <br />turia hours <br />Above TOC Below TQC <br />Is top of casing cut level? NO Iffh <br />Is well cap sealed and locked? NOIf <br />fo <br />If no, see remarks <br />Height of well casing riser (in inches) <br />na, see remarks <br />' <br />Well cover type 8" or 12" W 12" EMCO 8" or 12" BK $1. Chris�, <br />12" Christy t3" M&D_et 12" M&D 12" DWP <br />I2" CNi 36" M 12" Pomeco Other <br />General condition of wellhead assembly Excellent Good <br />� Fair <br />' <br />Poor <br />Purging Equipment 2" disposable bailer_Submersible <br />pump <br />2" PVC bailer <br />Dedicated bawler <br />—�4" P'V'C bailer <br />Sampled with Disposable barter �w Teflon bailer <br />,�_spCentnfugal pump <br />Diosable Tubing <br />' Well Diameter 2" 4" <br />—04-6 <br />6" g" <br />Purge Vol Multiplier 0 65 <br />147 2 —61—g al/f <br />Initial Measurement Rechaurgg Measurement <br />Time _z d,?[l a Time / h / 7 <br />Calculated purge t! <br />Depth well �r.�_q,�_ th water =s <br />Depto <br />, <br />0.91 Actual purge <br />Depth to <br />to water <br />iStart purge Sampling time- <br />! b. 8 <br />Sample appearance Lock <br />Equipment replaced (check all that apply) Note condition of replaced item(s) <br />2" Loclang Cap Lock 7/32 Allenhead. <br />4" Locking Cap Lock -Dolphin, 9/16 Bolt, <br />6" Locking Cap pinned Allenhead (DWP) <br />Remarks <br />• <br />'Signature, <br />