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SAMPL__ iG INFORMATION SHEET <br /> Client: Ramage Environmental Sampling Date: 03 <br /> Site: SJC Garage Project No . : <br /> i; 130 North Hunter street Well Designation : /K/W ` <br /> Stockton <br /> Is setup of traffic control devices required? O S time: - hours <br /> -- t ' Is there standing water in the well box? NO Above TOC Below TOC <br /> Is top of casing out 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 /> j Well cover type: 8" or 12" SIV 12" EMCO 8" or 12" BK 8" Chrisry. <br /> 12 " Cbnsty8" M&D7:W= 12" M&D 12" DWP <br /> I2" CM 36" CNI 12 " Pomeco Other: <br /> I. General condition of wellhead assembly: Excellent Good 7;;p Fair Poor <br /> Purging Equipment : 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> N 4" PVC bailer ?G Centrifugal pump <br /> Sampled with: Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: X0. 16 0. 65 1 . 47 2 . 61 gaUft . <br /> Initial Measurement Recharge Measurement s <br /> Time : / S Time : 2 Calculated purge : <br /> Depth of well : Depth to water: )a. �, Actual purger 6— <br /> Depth to water: . <br /> i ' f ' ' ,� � <br /> Start purge: e Jr Sampling time : i <br /> I l Time Temperature E. C. pH Turbidity Volume <br /> ii <br /> I ' Sample appearance: Lock: 19 � tri <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> I_ 2" Locking Cap : Tock: 7/32 Allenhead : <br /> 4" Locking Cap: Lock-Dolphin: 4/ 16 Bolt : <br /> 6" Locking Cap : Pinned Allenhead (DWP) : <br /> Remarks : <br /> I ' <br /> Signature : <br />