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SAMPLING INFORMATION SHEET <br /> Rama a Environmental Sampling Date: <br /> ' Site: 222 East Weber Street Project No.: <br /> Stockton Well Designation, �.. <br /> Is setup of traffic control devices required? �9 YES time hours <br /> Is there standing water in the well box? NO Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> a Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing user(in inches) <br /> well cover type 8"or 12"W I2"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Chnsty 8"M&Df!f, 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomecc Other <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"PVC bailer Centrifugal pump <br /> Sampled with- Disposable bailer, Teflon bailer isposable Tubing <br /> Well Diameter• '2" _ 4" 6" 8" <br /> Purge Vol Multiplier: 016 065 1,47 2.61 gal/ft <br /> Initial Measurement Recharge Measure ent <br /> Time, S" Time: = Calculated purge �• <br /> Depth of well Depth to water• Actual purge' - <br /> Depth to water: 5�• O[� <br /> Start purge. �= 2 Sampling time: ` �d <br /> Time Temperature pH Turbidi Volume <br /> 000 S 1 ® 0 2 <br /> 3 /_5 <br /> Sample appearance: f eek• <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Allenhead <br /> 4"Locking Cap: Lock-Dolphin- 9116 Bolt. <br /> 6"Locking Cap' Pinned Allen-head (DWP) <br /> Remarks <br /> i <br /> i <br /> t <br /> Signature' +' <br />