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DOULOS ENVIRONMENTAL INC. SAMPLING INFO TION SHEET <br /> Client Delta Env Sampling Date- <br /> Site 2537 Waterloo Rd (100966) Protect No . <br /> Stockton, CA Well Designation <br /> OR <br /> Is setup of traffic control devices required? CNU time hours <br /> Is there standing water in the well box9 NO Above TOC Below TOC <br /> Is top of casmg cut level? NO If no,see remarks <br /> Is well cap scaled and locked? NO If no,see remarks <br /> Height of well casing nser(in inches) �5 <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D I2"DWP <br /> 12"CNI 36"CNI 12"Porneco Other <br /> General condition of wellhead assembly ExcelIent Goode 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 Disposable Tubing___ <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial M asure ent Rechar a Measurement 3 <br /> Tune• <br /> Time. = Calculated purge C <br /> . Depth of weil > Depth to water - Actual purge - <br /> Depth to water <br /> Start purge Sampling time /1!5'-K 570 <br /> Time Temperature E C pH Turbidity Volume <br /> F <br /> 116,5 <br /> Sample appearance Lock, <br /> Equipment replaced (check all that apply) Note condition of replaced items) <br /> 2"Locking Cap Lock 7132 Allenhead <br /> 4"Lockmg Cap Lock-Dolphin, 9116 Bolt. <br /> 6"Locking Cap Pinned Allenhead(DWP), <br /> Remarks <br /> Signature <br />