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SAMPLING INFORMATION SHEET <br /> Sam lin Datc,- <br /> Client Rama e Environmental p g <br />' Project No <br /> Site 222 East Weber Street J <br /> Stockton Well Designation <br /> cy <br /> i <br /> s; Is setup of traffic control devices required YES time _hours <br /> Is there standing water in the well box9 Above TOC <br /> BelowTOC <br />' Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO 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"PV bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2'1 4" 6" g„ <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement RecharRe Measurement <br /> Time (, ,J:i. �,� Time -� Calculated purge . - <br /> �'i - Actual purge <br /> Depth of well �� �, �� Depth to water z. <br /> Depth to water 'Z - ' ,4y <br /> ' Start purge Sampling time - <br /> Time Tem eratui e E C pH Turbidity Volume <br /> 73 zz <br /> ' 3 , <br /> i <br /> aC. / <br /> Sample appearance Lock' /V/.O- <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 /> E <br /> l <br /> Signature <br /> l <br />