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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: c1 e? <br />• Site: Beacon #641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: u' — <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 I If no, see remarks <br /> Is well cap sealed and locked? N 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 12" CNI 36" CNI Other 2 P a Ec a <br /> General condition of wellhead assembly: Excellent ao Fair Poor <br /> it <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:"rP Teflon bailer: <br /> Well Diameter: 2"­�—<_ 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initialeasurement Recharge Measurement <br /> Time: 4 Time: f ' 1- 3 Calculated purge:4�7 <br /> Depth of well. �� e O Depth to water: 4 Actual purge: <br /> Depth to water IV <br /> - <br /> Start purge: -2 S Sampling time:_2 y _ <br /> Time Temp. E. C. pH Turbidity Volume <br /> y1 Vv -� <br /> ri <br /> Sample appearance: <br /> Lock: <br /> i <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: .,. <br /> Signature: <br />