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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client , Ultramar Diamond Shamrock Sampling Date , � o� <br /> Site *- Beacon , 641 __ Project No . : 98-641-01 <br /> 1210 East Hammer Lane Well Designation* 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 level? NO If no , see remarks <br /> Is well cap sealed and locked' NO S If no, see remarks <br /> Height of well casing riser ( in inches) : 4` <br /> Well cover type : 81' UV12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP T-2-rO-fNI _ 36" CNI Other <br /> General condition of wellhead assembly: Excellent F!fo S) 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: <br /> _S P Teflon bailer: <br /> Well Diameter : 2"�� 4" 61' s" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement 1 3 <br /> Time : l q ?- _ Time: 3 / Calculated purge <br /> Depth of well : 7 1 7 3 Depth to water: Actual purge r <br /> Depth to water: p <br /> Start purge: a Sampling time:-2 , 3- <br /> Time <br /> ime: fTime Temp. E. C. pH Turbidity Volume <br /> 12 ( 0 7 Y/ <br /> J2oO 7 30 -------- <br /> y69 <br /> ----yD . o r tg r-1 ? - 20 ----•� .3 <br /> L -J <br /> Sample appearance: Lock: *^�� <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : ._ <br /> Remarks : <br /> Signature: <br />