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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date <br /> Site 2537 Waterloo Rd 100966Protect No <br /> Stockton, CA Well Designation <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy YZ Above TOC Below TOC <br /> Is top of casing cut level? NO t= If no,see remarks <br /> Is well cap sealed and locked? rz NO IM If no,see remarks <br /> Height of well casing nser(nn inches) <br /> Well cover 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"CNI 36"CNI I2"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 .Xf 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 r' -0 Time I = Calculated purge <br /> Depth of well - Depth to water PZ Actual purge <br /> Depth to water !�2 2 t// <br /> Start purge // y Sampling time �- <br /> Time Tem erature EC pH Turbidity Volume <br /> Sample appearance e5& 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 9/16 Bolt., <br /> 6"Locking Cap Pinned Allenhead(DWP) <br /> Remarks. <br /> Signature, <br />