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DOULOS ENVIRONMENTAL INC. SAMPLING INFO TION 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? 1�b YES tune _ hours <br /> Is there standing water m the well box? ft us 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) _M __ <br /> Wellcover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D�_ 12"M&D 12"DWP <br /> 12"M36"CNI 12"Pomeca 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" _ 41' 6.P 81P <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> TimeTime- Calculated purge f, ' <br /> Depth of well.-- n Depth to water �_p�D Actual purge- <br /> Depth <br /> to water <br /> Start purge Sampling tune �- <br /> titi <br /> 15 � Time Temerature E C H TurbidityVolume <br /> Sample appearance. Lock <br /> Eqtupment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap' Lock 7/32 Allenhead <br /> 4"Locking Cap Lack-Dolphin, 9/16 Bolt, <br /> 6"Locking Cap Pinned Allenhead(DWP);_ <br /> Remarks• <br /> s <br /> Signature; ✓ <br />