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DOYTI,OS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date Z� <br /> Site 2537 Waterloo Rd (100966) Protect 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) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DW <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 /> 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 gaUft <br /> Initial Measurement Recharge Me urement <br /> Time Time 0� Calculatedpurge /t <br /> Depth of well —� Depth to water Actual purge Q` 't <br /> Depth to water <br /> Start purge .� Sampling tune1 -6 <br /> Time Temperature EC pH Turbidity Volume <br /> � <br /> a� e000tr �. <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"Locking Cap Lock-Dolphm 9/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWT) <br /> Remarks <br /> Signature' <br />