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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date b <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 there standing water in the well box? Yw Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked? C` NO If no,see remarks <br /> Height of well casing riser(iii in <br /> Well cover type 8"or 12"UVches � <br /> 12"EMCO 8"or 12"BK 8"clMsty <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"GNI 36"CNl 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 >IrTeflon 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 t Time 13 '2-ir Calculated purge <br /> Depth of well A- 0� Depth to water -6 Z -*9S Actual purge <br /> Depthto water 6 <br /> Start purge Sampling time - <br /> Time Temperature EC pH Turbidity Volume <br /> 3 <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-Dolphin 9116 Bolt. <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature' <br />