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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 V <br /> Is setup of traffic control devices required? YES time fours <br /> Is there standing water in the well box? Above TOC Below TQC <br /> Is top of casing cut level') NO If no,see remarks <br /> Is well cap sealed and locked? NO FS If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 12' EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D_ 12"DWP <br /> 12"CNI 36"CNI 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 Teflon bailer Disposable Tubing <br /> Well Diameter 2" __.�< 4" 613 S" -- <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Tame 1 I Tune 26 Ln-3 Calculated purge - <br /> Depth of well - Depth to water ./$" Actual purge <br /> Depth to water <br /> Startpurge /15 IsQ Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> 91 <br /> Sample appearance Lock1✓ ;� - T <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 />