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DOULOS ENVIRONMENT:_..r� COMPANY �PLING INFORMATION SHEET <br /> Client• UltgAMar Sampling Date:. R- 3 e-'9- 52 <br /> Site: Reacon 1474 Project No. : 94-474-01 - <br /> 3440 E Main 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? � YES Above TOC Below-TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NOS E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12V 12" EMCO 8'i <br /> X " U <br /> B <br /> 12" BK <br /> 12" DWP 12" CNI 36" CNi Other 12 r OM fC O <br /> General condition of wellhead assembly: Excellent �G"6d� 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:_,X Teflon bailer: <br /> Well Diameter: 2" 4" X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> 'tial Measurement Recharge Measurement y� <br /> Time: : Time: Calculated purge: <br /> :'� = Depth to water: Actual purgr <br /> e <br /> Depth of well: p <br /> Depth to water: <br /> Start purge: /2 Sampling time: <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" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> rrr.rrr�.w i i�r.��u.i-��u�.+u r�ur•i�� - <br /> Remarks: <br /> Signature: <br />