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DOVLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: U t am Sampling Date:— .,,,?- 3 <br /> Site: Beacon 1412 Project No. : 24-419-01 <br /> 2350 Waterloo-Road Well Designation: MW- <br /> Stockton CA <br /> Is setup of traffic control devices required? �W 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 /> In well cap sealed and locked? NO ?R� <br /> If no, see remarks <br /> Height of well casing riser (in inches) • 't <br /> Well cover type: 8" UV 12" UV_� " 12" EMCO er 8" BK <br /> 12" BK 12" DWP 12" CNI Excellent Fair Poor <br /> General condition of wellhead assembly: WMEMMMMOMMOMM <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S Teflon bailer: <br /> Well Diameter: 2" 4" 600 $ <br /> 01 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> asu ement echa a Measu ement <br /> Tnirial <br /> Time: 4 6 ' Time: Calculated purge: <br /> Depth of well: Depth to water: G 3 Actual purge: <br /> G <br /> Depth to water: '�S Z 7 _. <br /> Start purge: O Sampling time: ZZ=� <br /> Time Temp. E.C. pH Turbidity Volume <br /> if --/0 70 <br /> !/ d 6 7 <br /> -7 CO <br /> Sample appearance: r+w_ Lock: � Wd <br /> Equipment replaced: (Check all that apply) <br /> Note conditidn 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) : <br /> Remarks: <br /> Signature: <br />