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' SAMPLING INFORMATION SHEET <br /> Client Rama a Environmental Sampling Date © C/ <br />' <br /> Site 222 East Weber Street Protect No <br /> �� <br /> G Stockton Well Designation 3 � <br /> , <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casuig 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_y 12" M&D 12" DWP <br /> 12"CNI 36"CNI 12" Pomeeo 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 X Centnfugal pump <br /> Sampled with Disposable bailer s— Teflon bailer Disposable Tubing <br /> Well Diameter 2" _ 4" 6" 8" <br />' Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement -� 3 <br /> Time Time %/ Calculated purge <br /> Depth of well Depth to water Actual purge <br /> Depth to water ljS.48– <br />' Startpurge Sampling time <br /> Time Temperature EC PH Turbidity Volume <br /> 125 <br /> f <br /> 1 � <br /> I <br /> i <br />' Sample appearance Lock 'g <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 (DWP) <br /> . Remarks <br /> Signature <br /> 1 <br />