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] }} SAb ING INFORMATION SHEET <br /> DOQLOS ENVIRONMENTAL -JMPANY <br /> Client: <br /> Sampling Date: <br /> Site:__ Beacon 1412 Project No. : 91-419=9,1- <br /> 23 <br /> Wa o o Well Designation: - <br /> Stockton CA <br /> YES time:�_�. hours <br /> Is setup of traffic control devices required? XW Above TOC Below TOC <br /> Is there standing water in well box? NO If no, see remarks <br /> in top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? <br /> Height of well casing riser (in inches) : �� 8u BKS_ <br /> 12 It 12 EMCO� <br /> Well cover type„ 8 W-•-�'12�� CNI 6" CNI Other 1 <br /> 12" BK._� 12 DWP_�^ <br /> General condition of wellhead assembly: Excellent Good Fair poorwomm <br /> 2" disposable bailer _Submersible PUMP <br /> Purging Equipment: ____Dedicated bailer <br /> 2" PVC bailer rCentrifugal pump <br /> 411 PVC bailer ---- <br /> Sampled with: Disposable bailer:, <br /> Teflon bailer: �- <br /> Well Diameter: 2" 4 <br /> n� 61' Sn�+. <br /> 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> ge Vol. Multiplier: ar a Me a eft ��3 <br /> Time: <br /> Initial Meassuremen� Rer Calculated purge: <br /> Time: s3 Depth to water: �- Actual purge: <br /> Depth of well: <br /> Depth to water: <br /> Start purge:_ 1-5-5 Sampling time: <br /> Time Temp. E.C. <br /> --------PH Turbidity Volume <br /> I <br /> i 74 / <br /> 307 -91e0 <br /> -311 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> Lock #3753 :l� 7/32 Allenhead:,,—_— <br /> 2" P Locking Cap:,_, 9/16 Bolt:----,4" Locking Cap: _ Lock-Dolphin:,y— <br /> " Locking Cap: <br /> Pinned Allenhead (DWP) :�..,�- <br /> Remarks: <br />�Sianatur.e: _ <br />