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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamroc-IS Sampling Date: <br /> • Site: Beacon 1641 Project No. : 98-641-01 <br /> 210 East Hammer Lane Well Designation: R" L4Z — 5 <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well boxy YES Above TOC Below TOC <br /> Is top of casing cut level? NO 67ffikIf no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : . +_2 <br /> Well cover type: 8" UV12" OV_ 12" EMCO 8" BK_ <br /> 12" BK 12" DWP k,',F,,4CNI_><_� 36" CNI� Qther <br /> General condition of wellhead assembly: Excellent 76z;dd) 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: f� Teflon bailer: <br /> Well Diameter: 2" 4'1 X, 6" gr, <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> JQTnitial measurement e h e s me t 7 �. d <br /> Time:_�..�..,_ Time• Calculated purge: <br /> Depth of well: 3 �f Depth to.water: � - 7 Actual purge: - d <br /> Depth to water: <br /> Start purge: 3 = ?t Sampling time: 3 : <br /> Time Temp. E.C. pH Turbidity Volume <br /> o <br /> 3or- <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 />