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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date <br /> Site 2537 Waterloo RA_C100966 Project No <br /> Stockton, CA Well Designation /Lt- <br /> Is setup of traffic control devices required? YES time _hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top of casmg cut levels NO If no,see remarks <br /> Is well cap sealed and locked? NO ez If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"W 11"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Chnsty 8C5MDZf`'j 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent GoodRI�k 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 a Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier U 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time 3 Calculated purge • <br /> Depth of well G Depth to water .Z k Actual purge <br /> Depth to water <br /> Start purge ,**,D = Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> rz <br /> • -� /� o �r <br /> Sample appearance - F Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7132 Allenhead <br /> 4"Locking Cap Lock-Dolphin, 9116 Bolt. <br /> 6"Locking Cap Pinned Allenhead (DWT,) <br /> kA' <br /> Remarks <br /> Signature: <br />