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DOUOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date, <br /> • Site 2537 Waterloo Rd (100966) Protect No <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? NO YES tune _hours <br /> Is then standing water in the well box? NO YES Above TQC Below TOC <br /> Is top of casing out level? NO YES ,. If no,see remarks <br /> Is well cap sealed and locked? NO YES If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Chesty <br /> 12"Christy 8"M&DN,..# _ 12"M&D I2"DWP <br /> 12"CM 36"CNI 12"Poineco Other <br /> General condition of wellhead assembly Excellent Good 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" $„ <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement { <br /> Time :6 Time f 2.!03 Calculated purge .� <br /> . Depth of well - Depth to water , 7 T Actual purge <br /> Depth to water <br /> Start purge Sampling tune Z '2 <br /> Tune Temperature E C pH Turbidi Volume <br /> tv <br /> el <br /> Sample appearance det_ Lock' 1• �" ' <br /> Equipment replaced- (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock' 7/32 Allenhead <br /> 4"Lockmg Cap, Lock-Dolphin 9/16 Bolt. <br /> 6"Locking Cap Pinned Allenhead (DWP). , <br /> Remarks <br /> t <br /> Signature: <br />