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l <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORIKATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: L) 3 � - <br /> Site: Beacon #641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: <br /> Stockton CA <br /> Is setup of traffic control devices required? CO YES time: hours <br /> Is there standing water in well box? (M> 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) : 1 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP iA-w N I K 36" CNI Other <br /> General condition of wellhead2asembly: Excellent eCW4 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: 2"-X- 4" 6" 8'r <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge- Measurement p g <br /> Time: 1 So Time: Calculated ur 4 <br /> Depth of well: SS' e5_ Depth to water: �� Actual purge: /li <br /> Depth to water: V 7 3 S <br /> Start purge: jam/ Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> LC <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 />