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t <br /> DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultrgmar Sampling Date: <br /> 5ite• Beapon <br /> Project No. : 94-412-01-- <br /> 235o <br /> WA&er1go ad Well Designation: MW- 10 <br /> Stockton, CA <br /> _ hours <br /> Is setup of traffic control devicesrequired? YES Above.TOC Below TOC <br /> Is there standing water in well box' NO If no, see remarks <br /> Is top of casing cut level? NO <!f9PIf no, see remarks <br /> Is well cap sealed and locked.' <br /> Height of well casing riser (in inches) : <br /> " 12" EMCO <br /> Well cover type8UV 12 UV — til C d <br /> y 12" CNI 36" CHI— her <br /> 12" BK 12" DWP_ Fair Poor <br /> General condition of wellhead assembly: Excellent <br /> 2" disposable 4 <br /> ble bailer " Submersible pump <br /> Purging Equipment: Dedicated bailer <br /> 4" PVC bailer <br /> PVC bailer �rcentrifugal pump <br /> 4" <br /> Sampled with: Disposable bailer: S P Teflon bailer:__ <br /> well Diameter: 2" 4" 611 810_ <br /> Purge Vol. Multiplier: 0 .16 . <br /> 0. 65 1.47 2. 61 gal/ft. <br /> Rec a e Measurement O f <br /> r..;Tial Measurement Calculated purge: <br /> Time: � Time: / <br /> Depth of well: 6 1- y Depth to water: G Actual purge: b-4 <br /> Depth to water: -7 <br /> r 4 Sampling time: f0 <br /> Start purge:, � — <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> ------------ <br /> Ll <br /> � S <br /> , S -7. 25 <br /> Sample appearance: <br /> Lock: •f <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) :46 �� <br /> Remarks: <br /> Signature: <br />