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DOULOS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date. •G-�O - Ca <br /> Site, 2537 Waterloo Rd 100966 Project No, <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? CNO YES tune hours <br /> Is there standing water in the well box? NO Above TOC Below TOC <br /> 1 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) <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 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco 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" 43) 6" g» <br /> Purge Vol Multiplier Q - 065 147— 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time- .'t7 Time Calculated purge <br /> Depth of well: - Z�� Depth to water Actual purge . <br /> Depth to water <br /> Start purge- �� Sampling time b <br /> Time Temperature E C PR Turbidity Volume <br /> ' l z `` <br /> zz <br /> Sample appearance Lock 0 � <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"Locking Cap- Pinned Alleiitlead (DWP) <br /> Remarks. " <br /> t - <br /> Signature, <br />