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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site:___ Beacon 641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation : V W <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 leveler NO If no, see remarks <br /> Is well cap sealed and locked? Nq- <br /> l Q If no, see remarks <br /> Height of well casing riser (in inches) : ? <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP CNI_ = 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer : <br /> Well Diameter: 211 <br /> _.Z. 4" 6" all- <br /> Purge <br /> "Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 61 gal/ft. <br /> Initial Measurement Rechargf.% Measurement g <br /> Time: 2­ L ?Time: Calculated purge : <br /> Depth of well : S� 3 Depth to water: Z Actual purge : <br /> Depth to water • L1 • S O <br /> Start purge: 7 ' 2 d Sampling time: '7 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7, 2 Gg - / /owl 7 -.?o I <br /> 7 x 2 2 9 - y 1toga 7 -2 t ----� z <br /> : 2 2 Gq 3 7- /1 3 <br /> 7 . 23 G •1 � � 7- ��' Y <br /> Sample appearance : Lock: <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead - <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks: <br /> Signature - <br />