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DOVLOS ENVIRONMEIAL COMPANY SAMPLING INFORMATIONN SHEET <br /> ^ �— � <br /> Client: t Sampling Date:_ 3 - ` <br /> Site: Beacon Project No. : 94-474-01 <br /> 3440 g., Ma Street Well Designation: MW- <br /> Stockton. C <br /> Is setup of traffic control devices required? YES time:. hours <br /> Is there standing water in well box? 4 YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> S <br /> Is well cap sealed and locked? No If no, see remarks <br /> Height of well casing riser (in inches) : <br /> 8" �K <br /> Well cover type: S" UV12" W 12" EMCO <br /> 12" BK 12" DWP 12" CNI 36" CNI Other /d <br /> General condition of wellhead assembly: Excellent <poVt 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:—=e Teflon bailer: <br /> Well Diameter: 2" 4"� 6" sit— <br /> Purge <br /> "Purge vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> TnitjAl Measurement Recharge Measurement <br /> Time• Time: 3 = / Calculated purge: <br /> Depth of well: $ ' y� Depth to water: -- �,F- Actual purge: <br /> Depth to water: <br /> Start purge: .� <br /> �D Sampling time: '�8 <br /> Time Temp. E.C. pH Turbidity volume <br /> 17 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> . 4" Locking Cap: Lock--Dolphin: 9/16 Bolt: <br /> 61' Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br />