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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: Ud <br /> Site: Beacon 641 Project No. : 98-641--01 <br /> 1210 East Hammer Lane Well Designation:, /I' W-3 _ <br /> Stockton CA <br /> Is setup of traffic control devices required? J@ YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NSE If no, see remarks <br /> Is well cap sealed and locked? NO }TP If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" LTV 12" !�EMCO $ BK_.r_ <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer ,,Dedicated bailer <br /> �4" PVC bailer �Z Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2"�_ 4t+ 6" $" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Amkinitial-Measurement Recharge Measurement Calculated purge: �L <br /> Time: 5 <br /> Depth of well: Depth to water: L Actual purge: . <br /> Depth to water: }' <br /> Start purge: 31 a Sampling time: 3 3 6 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 313 79 <br /> 3 z7 - <br /> 6'4 -<a -7/y � <br /> 3 <br /> Sample appearance: " Lock: <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 /> 01 Remarks: <br /> a / �� I <br />