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DOULOS ENVIRONMENTAL `4�WANY SAM �NG INFORMATION SHEET <br /> Client: Ultramar Diamond Shamro_cjS Sampling Date: <br /> Site: Beacon 1641 Project No. : 28-641-01-- <br /> 1210 East Hammer Lane Well Designation:., /`IW - _ <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 E If no, see remarks <br /> Height of well casing riser (in inches) : tl <br /> Well cover type: 8" UV12" UV12" EMCOth8" BK <br /> 12" BK 12" DWP 12" CNI .1.8" CNIA ,_ %ther_General condition of wellhead assembly: Ellent 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: 5- -� <br /> Well Diameter: 211 400 610 gn <br /> Surge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> rnitial Measurement_ Rechar a Measureme t 1,1 <br /> Time: Time: Calculated purge: <br /> Depth of well: 73i �Q Depth to water: Actual purge: <br /> Depth to water: u9 55 <br /> Start purge: Sampling time:_ 743 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7/ <br /> 7JS 21, 0 <br /> 7J- L) K-'.L -? 9 <br /> � W- �� ; �i 1 7/r <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: <br /> Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />