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DOULOS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date <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 m the well boxy VRIQ Above TOC Below TOC <br /> Is top of casing cut levels to If no,see remarks <br /> Is well cap sealed and locked9 NO If no,see remarks <br /> Height of well casing riser(in me s) <br /> Well cover type S"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CI1I 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good'&L Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PF bailer Centrifugal pump <br /> Sampled with Disposable bailer sl Teflon bailer Disposable Tubing ^ <br /> Well Diameter 2" 4" -R/ 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurem t Recharge Measurement <br /> Time _ Time J�/V Calculated purge50 <br /> Depth of well so Depth to water Actual purge <br /> Depth to water Ce 2_ 5,1 <br /> Start purge l G - �.� Sampling time <br /> Time Temperature E C 2H Turbidity Volume <br /> / <br /> 02 EDO <br /> Sample appearance Lock 6f <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, 9/16 Bolt, <br /> 6"Locking Cap Pinned Allenhead (DWT) <br /> Remarks <br /> Signature. <br />