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DOUL05 ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client ltramar Sampling Date: 6 — 16—o y <br /> M <br /> Site: _Beacon #3641 Project No : <br /> 1210 E,Harnmer Lane]400 Well Designation; M tA_1 — <br /> Stockton Ca, <br /> Is setup of traffic control devices required? YES timet ;hours <br /> Is there standing water in the well box? YES 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 remark <br /> Height of well casing riser(in inches): <br /> Weil cover type: 8"or 12"U.V 12" EMCO 8"or 12"BK 8" Chri4ty <br /> 12"Christy 8"M&D 12"M&D 12"Dyyp l� <br /> 12"CM 36" CNI 12"Pomeco Other: _ <br /> Genoral condition of wellhead assembly: Excellent Qood < _ •Fair <br /> Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer - D6dicated bailer- <br /> _4"PVC bailer . CtIntrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Dispos4ble Tubing < <br /> Wel! Diameter; 2" 4» 6" $;, <br /> Purge Vol, Multiplier: 0,16 0.65 1.47 <br /> 2,61 gal/it.Initial Measurement <br /> Recharge Measurement ' <br /> Time:_ e, ?a Time: gCalculated purge: <br /> Depth of well: .213. 3 �! Depth to water: S S S Actu4l purge: <br /> Depth to water:_ _ 1 <br /> Start purge; Sampling time: R 3 <br /> Time Tem erature E.C. H . Turbidi Volume <br /> 1 ' <br /> = 23 6 C1 1 v f <br /> ` 2 q c7 <br /> . cf, s8 . y <br /> Sample appearance; Lock, <br /> Equipment replaced: (check all that apply) Note condition of repiac cl item(s) <br /> 2"Locking Cap: Lock: 7/32 Alientlead: <br /> 4"Locking Cap: Lock-Dolp� hin ,16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP), <br /> Remarks: <br /> Signature: <br />