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r <br /> YSAMPLING INFORMATION SHEET <br /> DOUL08 ENVIRONMENTAL COMPANY <br /> Client: Ultramar Diamond Shamrock Sampling Date: 73r <br /> Site: Beacon f641 Project NO. : 98-641-01 <br /> Z 10East Hammer La a Well Designation: w 3 <br /> Stockton CA <br /> Is setup of traffic control devicesrequired? YES time:. <br /> im Above:BelowursC <br /> rs <br /> Is there standing water in well box,. If no, see remarks <br /> Is top of casing cut level? 0 <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser ( in inches) : 12,+ EMCO______ 8" BK _ <br /> Well cover type: 8" UV 12" UV_ <br /> 12" BK 12" DWP 12" CNI Excelle3611 CNI nt dG51 Fair Poor <br /> General condition of wellhead assembly: <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: P Teflon bailer: <br /> 2 <br /> Well Diameter: " 4" 6 <br /> ,1 8,0 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> ern{*ial Measureme t Re e s e e <br /> 'Time r - 0 Time: Calculated purge: <br /> Depth of well: 7 V -y s Depth to water: �S•�� Actual purge <br /> Depth to water: <br /> Start purge: <br /> r Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Gy a 12 ? e? - '2J <br /> S7 61Y • / / 2 q 7 . <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 />