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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? time _hours <br /> Is there standing water m 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 If no, see remarks <br /> Height of well casing riser(in inches) ,p <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"EK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CM 36"CM 12"Pomeco o Other <br /> General condition of wellhead assembly Excellent Goody 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" V <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial M asllremerif , Recharge Measurement <br /> Time : Time ., C Calculated purge <br /> Depth of well, - Depth to water Actual purge <br /> Depth to water <br /> Start purge ' Sampling time 3 <br /> Time lTem esrature E/C pH Turbidity Volume <br /> An <br /> . --� <br /> Sample appearance Lock- <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 Purred Allenhead (DWP) <br /> Remarks: <br /> s <br /> Signature: <br /> t <br />