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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: L <br /> • <br /> Site: Beacon #641.- Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: <br /> 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? Amn If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 12' Cp� 8" BK <br /> Well cover type: 8" W / 12" w- „ ther <br /> 12" BK 12" DWP ' yCNIS_ 36 CNI Fair Poor <br /> General condition of wellhead a'ssembly: Excellent <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:_Xr_4_P Teflon bailer: <br /> Well Diameter: 2" 6 <br /> 19 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial e e <br /> Tine:_ e' su e e Time: '3 : 0 Calculated purge: � <br /> Depth of well. 7 q 3 Depth to water: Actual purge: Z • <br /> Depth to water:_ <br /> Start purge: 3 o / Sampling time: 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> a ro G3 o r2 io -� - Z <br /> 3 �- <br /> '? <br /> Sample appearance: Lock: Q <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 />