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DOULOS ENVIRONMENTAL.INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date <br /> Site 2537 Waterloo Rd (100966) Project No <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? tune 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 IrAp If no, see remarks <br /> Height of well casing riser(in niches) <br /> Well cover type 8"or 12"LTV 12' CO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DW <br /> 12"CNI 36"CNI 12"Porneco Other <br /> General condition of wellhead assembly Excellent" Good Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> Z"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 0 147 2 61 gal/ft. <br /> Initial M asurement Recharge Measurement <br /> Time Tunes Calculated purge 5 <br /> Depth of well Depth to water L Actual purge <br /> Depth to water .- <br /> Start purge tek,,' Sampling time <br /> Tune Temperature E.C. H Turbidi Volume <br /> 95;12- <br /> el' ZS <br /> YJ <br /> Sample appearance Lock <br /> I <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 9/16 Bolt, <br /> 6"hocking Cap. Pinned Menhead (DWP), <br /> Remarks <br /> Signature: <br />