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r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon #641 _ Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: w' y <br /> Stockton, CA <br /> Is setup of traffic control devices required? 416% YES time: hours <br /> Is there standing water in well box? �fflo YES Above TOG Below TOC <br /> Is top of casing cut level? NO 1!!%10 If no, see remarks <br /> Is well cap sealed and locked? NO� L� If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type: 8" UV 12" UV12" EMCO 8 0011BK <br /> 1211 BK 12" DWP 1211 CNI 3611 CNI Other Z � <br /> General condition of wellhead assembly: Excellent sr 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: s P Teflon bailer: <br /> Well Diameter: 2" 4116" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial easurement Recharge Measurement <br /> Time: Time : Calculated purge: � - <br /> Depth of well: / � �Q Depth to water: 4( 7 1 dr Actual purge: <br /> Depth to water:_Y__ 32 <br /> Start purge: -3Sampling time: Z <br /> Time Temp. E. C. pH Turbidity Volume <br /> J ✓ <br /> Sample appearance: Lock: <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 />