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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date —9v-S71 0-Y <br /> • Site 2537 Waterloo Rd (100966) Project No <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? YES time hours <br /> Is thi:re standing water in the well boxy is W Above TOC Below TOC <br /> Is top of casing cut level? NO fvutp If no,see remarks <br /> Is well cap sealed and locked? IT NO If no,see remarks <br /> Height of well casing user(in inches) <br /> Well cover type 8"or 12"UV k 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty 8'��fis 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent GoodFair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bw1cr <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer_ %we _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" � 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time :do Time l 0 w_1-3 Calculated purge 0 <br /> Depth dwell l Depth to water Actual purge <br /> Depth to water & :�- <br /> Start purge Sampling time <br /> Time Temperature E C PH Turbidity Volume <br /> ev <br /> r � <br /> Sample appearance Lockf ���i6 <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. 9116 Bolt, <br /> 6"Locking Cap Pinned AIlenhead (DWP) <br /> Remarks <br /> Signature: <br />