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DOULOS ENVIRONMENTAL.INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date' 22 <br /> Site 2537 Waterloo Rd 100966 Project No <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? NQS tune _fours <br /> Is there standmg water to the well box9 NO 5+�S, Above TOC Below TOC <br /> Is top of casing cut level? NO gg If no,see remarks <br /> Is well cap sealed and locked? "7 NO If no,see remarks <br /> Height of well casing reser(m inches) <br /> Well cover type 8"or 12"W 12""MCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNII 36"CNi 12"Pomeco Other <br /> General condwon 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/f $» <br /> Purge Vol Multiplier' D 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time :a " ' Time Calculated purge . <br /> Depth of well Depth to water 7 63 Actual p fte' <br /> Depth to water <br /> Start purge, ' : <br /> � Safmpling time __} 7 <br /> Time Tem erature E C. pH TurbidityVolume <br /> }Jr F <br /> 1 <br /> Sample appearance. Lock <br /> Equipment replaced' (check all that apply) Note condition of replaced item(s) <br /> 2"Lacking CapLock +� 7/32 Allenhead <br /> 4"Locking Cap v Lock-Dolphin: 9/16 Bolt. <br /> 6"Locking Cap Pinned Allenhead (DWP)' <br /> Remarks <br /> Signature: <br />