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SAMPLING INFORMATION SHEET <br /> Rama e Evniromental Sampling Date �t <br /> Site AG Manteca Project No <br /> 392 South Moffat Boulevard Well Designationi'l. . ''� <br /> ' Manteca, CA <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water m the well box? 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(m inches) — <br /> L V <br /> Well cover type 8"or 12"LTV 12"EMCO 8"or 12"BK 8"Chnsty <br /> ' 12" Chnsty8"M&D 12"M&D 12"DWP <br /> 12"C I 36"CNI 12"Pomeco Other o !, <br /> General condition of wellhead assembly Excellent Good-�< Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PV bailer Centrifugal pump ' <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8„ <br /> Purge Vol Multiplier. 0,16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ,5� Time e Calculated purge , <br /> Depth of well - Depth to water Q Actual purge [ <br /> Depth to water <br /> Start purge' O ,' e- Sampling time �p <br /> , <br /> ' Time Temperature EC <br /> pH Turbidi Volume <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply) Note condition of replaced itern(s) <br /> ' 2"Locking Cap Lock 7132 Allenhead <br /> 4"LockingiCap- Lock-Dolphin 9/16 Bolt. <br /> 6"Locking;Cap Pinned Allenhead (DWP) -- <br /> Remarks ��iyv-c it _ <br /> Signature: <br />