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F <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br />� <br /> Client:--Ultramgr <br /> Sampling Date: <br /> Site: Deacon #419 Project No. : 94-4191 <br /> 225o Waterloo Road Well Designation: MW- .1 <br /> Stockton CA <br /> Is setup of traffic control devicesrequired? YES time: <br /> iro e•TOC Below TOC <br /> hours <br /> Is there standing water in well box.' if no, see remarks <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked.' <br /> Height of well casing riser (in inches) : 12 11 EMCO�- 8" BK_- <br /> Well cover type: 8" UV 12 UV_ <br /> V 36„ CNr Other <br /> 12" BK 12" DWP 12" CNI Fair Poor <br /> General condition of wellhead assembly: Excellent <br /> ?C Submersible pump <br /> Purging Equipment: V„ disposable <br /> pbailer bailer Dedicated bailer <br /> 4" PVC bailer r Centrifugal pump <br /> Sampled with: Disposable bailer: J P Teflon bailer: <br /> Well Diameter: 2" <br /> 4" 6" 8" <br /> Purge Vol. Multiplier: 4. 16 <br /> 0. 65 1.47 2. 61 gal/ft. <br /> Tniti easu ement Recha a Meas reme Calculated purge: 0 y�u <br /> Time: � Time: � y 7 /Q Actual purge: 4 <br /> Depth of well: g S 2 '/ Depth to water: <br /> Depth to water: <br /> Start purge. <br /> Sampling time: <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> r f/ ' <br /> Sample appearance: <br /> v Lock. <br /> � <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead:`. <br /> 4" Locking Cap: _ Lock-Dolphin:- 9/16 Bolt:��_ <br /> 6" Locking Cap: Pinned Allenhead (DWP) :r�, <br /> Remarks: <br /> Signature: <br />