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SAMPLING INFORMATION SHEET <br /> Client Ramage Environmental Sampling Date '"��` <br /> Site 222 East Weber Street Project No <br /> Stockton Well Designation <br /> Is setup of traffic control devices required9 us 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 /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches) z <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy8"M&D�- 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco 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"PV bailer Centnfiigal pump <br /> Sampled with Disposable bailer Teflon bailer isposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal./ft <br /> Initial Measurement Recharge Measurement <br /> ime /0- S9- Time OZ-2t' `Z` Calculated purgez/.,3 <br /> epth of well Z Depth to water g Actual purge <br /> Depth to water <br /> Start purge "2 •' Sampling time <br /> Time Tem eratute E C pH Turbidity Volume <br /> i <br /> Sample appearance (� ®Gc Lock ^_ <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 Allenhead (DWP) <br /> • Remarks <br /> Signature <br />