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r <br /> t <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date:_ ` -31 ` <br /> Site: Beacon #641 Project No. : 98-641-01 <br /> 10 East Hammer Lane Well Designation: <br /> IV Gv --3 <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 Ong If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: S" W 12" UV12" EMCO 8" BK, <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent "�W Fair Poor <br /> Purging Equipment: 2" disposable bailer X` Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable baller:_,_4P_ Teflon bailer: <br /> Well Diameter: 211-XIr 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measu ement Recharge Measurement C8 <br /> - <br /> Time: / ed' Time: r ^ D Calculated purge: a <br /> Depth of well: 7/ y� Depth to water: d Actual purge: A <br /> Depth to water: �' / — <br /> Start purge: C= 5 C1 Sampling time: /zq <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance : Lock: r <br /> 001 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />