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t <br /> DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: U t amar Diamond Shamrock Sampling Date: ' 3 <br /> Site: Beacon A641 Project No. : 9. 8-641-Q.l <br /> 0 East Hammer Lane Well Designation: V w ' S <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 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" W 12" EMCO 8" BK_ <br /> 12" BK 12" DWPCNI '� 36" CNI I Other <br /> General condition of wellhead Issembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PUC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 4" 611 $11 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> nitial measurement Re * ar Measurement 1-t <br /> Time: J IV D 7� Time: Calculated purge: <br /> Depth of well: Depth to water: •�P47 Actual purge: <br /> Depth to water: <br /> Start purge: <br /> Sampling time: Al ' I <br /> Time Temp. E. C. pH Turbidity Volume <br /> 'hG4. 4 ooS <br /> 00, <br /> �I tr d <br /> E: OF <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 />