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DOULOS ENVIRONMENTAL JMPANY SAM ING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon #641 Protect No. : 98-641!01_ <br /> 1210 East Hammer Lane Well Designation: M t <br /> Stockton CA <br /> time <br /> Is setup of traffic control devices required? * YES Above:TOC Belowurs TOC <br /> Is there standing water in well box. NO � if no, see remarks <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? +112 <br /> Height of well casing riser (in inches) : 12" CO- <br /> Well <br /> BKS <br /> Well cover type: 8" W� 12 SUV 36" CNI they <br /> u <br /> 121+ BK 12" DWP CNI ExcelleFair <br /> Poor <br /> General condition of wellheadssembly: Excellent <br /> 2" disposable bailer Submersible pump <br /> Purging Equipment: Dedicated bailer <br /> 2" PVC bailer 'Centrifugal pump <br /> 411 PVC bailer <br /> Sampled with: Disposable bailer.• S Teflon bailer: <br /> u <br /> well Diameter: 2" 4 6" gn <br /> 0.65 1. 47 2 . 61 gal/ft. <br /> Purge Vol. Multiplier: 0. 16 Bechar a Measurement 3 , g ,LI <br /> xn tial Measuremesit Calculated purge.• <br /> Time: 2 so Time: C= [ Q Actual purge:Z <br /> Depth of well: -7�1 73 Depth to water: �(•� <br /> Depth to water: 4 z <br /> Start purge: <br /> Sampling tune• I <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> X33 <br /> l07 ` � <br /> S- Doi- (o Co . �-1 11 09 7Z l <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> Lock #3753 :-, 7/32 Allenhead: ..^ <br /> 211 Locking Cap: 9/16 Bolt: <br /> 4" Locking Cap:- Lock-Dolphin:_ <br /> Pinned AZlenhead (DWP) : <br /> 6" Locking Cap•_ _ <br /> Remarks: <br /> Signature: <br /> I <br />