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DOVLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> G-G -oo <br /> Site : Beacon 1641 Project No. : 98-641-01 - <br /> 1210 East Hammer Lane , Well Designation: ~ ` <br /> Stockton. CA <br /> Is setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box' YES Above TOC Below TOC <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) : -f- <br /> Well <br /> Well cover type: 8" W 12" UV 12" EMCO 81' BK <br /> 12" BK 12" DWP 'gCNI� 36" CNI Other <br /> General condition of wellhead assembly: Excellent o 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: <br /> Well Diameter: 2"-Z_ 4" 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Tnitigl Measurement Recba su ement 8 <br /> Time: o Time: CI C�/ Calculated purge: <br /> Depth of well . ' s Depth to water: 3 " Actual purge <br /> Depth to water: `l� f <br /> Start purge: = 3 Sampling time:r.s y 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7- V z <br /> =3e!�' 67 7 - 2S- <br /> 7 32 <br /> S-:32 67 6 7- z 3 <br /> Sample appearance: ���cs�� Lock: ' <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock (3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br />• 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Siqnature: <br />