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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: UltramgX Sampling Date: <br /> Site: Agacon 1419 Project No. : 94-419=D-L- <br /> 2350 <br /> 4-4 9- <br /> 2 50 Wate o Road Well Designation: - <br /> Stockton CA <br /> is setup of traffic control devicesrequired? Np YES time:_ hours <br /> Below TOC <br /> Is there standing water in well box.' rg If no, see remarks <br /> Is top of casing cut level? No If no, see remarks <br /> Is well cap sealed and locked? <br /> Height of well casing riser (in inches) • �� 8-' BKS,_ <br /> Well cover type: 8" W �1-LrWr---36n CNICOr her <br /> 12" BK— 12" DWP— 12 CNI <br /> General condition of wellhead assembly: Excellent o Fair poor <br /> Purging Equipment: 2" disposable bailer _Submersible pump <br /> 2" PVC bailerDedicated bailer <br /> �4" PVC bailer .Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> � <br /> Well Diameter: 2"� 4"_ 6 ---- <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Measurement Recharge NeasurementCalculated purge: 0 0,a <br /> ime; 16U6 Time: Actual purge: <br /> Depth of well: 1+. Depth to water: <br /> Depth to water: <br /> Start purge: Sampling time:—,' 7 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6 21 <br /> '�71 <br /> ' 3 <br /> �4 G it/ /)A-C 74 <br /> Sample appearance: CAsa--- Lock: <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) : <br /> Remarks: <br /> Signature: <br />