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L <br /> DOUL08 ENVIRONMENT)%- COMPANY .�PLING INFORMATION SHEET <br /> Client: 111tramAr Sampling Date:_ <br /> Site: Beacon 1414 Project No. : 94-474-01 _ <br /> 3440 E Mai Street Well Designation: MW_ <br /> Stockton, CA <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) : -3 <br /> Well cover type: 8" W 12" W 12" EMCO 811 BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other PoM FC O <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:'Lp Teflon bailer: <br /> Well Diameter: 2" 4" 6" Sol- <br /> Purge <br /> "Purge Vol. Multiplier: 0 . 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ► 4 = Time:=-' Calculated purge: <br /> Depth of well: 76 Depth to water: /6 Actual purge: <br /> Depth to water: <br /> Start purge: �� Sampling time: 1 <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearance: - Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Lacking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />