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_ C <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon J641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: (/ 3 <br /> Stockton CA <br /> Is setup of traffic control devices required? AED YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO 1"N <br /> If no, see remarks <br /> Is well cap sealed and locked? NO/ 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 `2CNI. 36" CNI Other <br /> General condition of wellhead %sembly: Excellent oo 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: Teflon bailer: <br /> Well Diameter: 21f� 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement `� <br /> Time: C_ 3 Time: Calculated purge: <br /> Depth of well: S y Depth to water: -/ 7 Actual purge: <br /> Depth to water: 6 <br /> Start purge: y � s Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearance: Lock: //C� /E!r.,,�✓` <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 />