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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beaco 41 Project No. : 8-641-01 <br /> 1210 East Hammer ane Well Designation: y W <br /> Stockton, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well boxy a YES Above TOC Below TQC <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) : +10 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BY <br /> 12" BK 12" DWP %LCNI, Ks 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:_2!L_ Teflon bailer: <br /> Well Diameter: 211 _ 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial- Measurement Re-cl2arge Mggsurement2 <br /> Time: - � 3 Time: Calculated purge: <br /> Depth of well; -5't5 Depth to water: Y 2 Actual purge : <br /> Depth to water: `t I - 7 6 <br /> Start purge: G = .2- y Sampling time: ,, 6 3� <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6. 2y 41-1 3 �-~- <br /> �' 2 GS- 7 1 // /0 11 <br /> TIS <br /> Sample appearance: 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 />