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S <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site:- Beacon #641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation: <br /> Lt! <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: <br /> hours <br /> Is there standing water in well box?required? * <br /> Above TOC Below TOC <br /> If no, see remarks <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NO <br /> Height of well casing riser ( in inches) : 12 �EMCO <br /> r1 12 UV 1� --�- 8!r O d <br /> Well cover type: 8 W 3611 CNI Other 1 Z C' <br /> 12" BK 12" DWP� 12" CNI,_� <br /> General condition of wellhead assembly: Excellent oo 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" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> 'tial easu eme t Recha a Measurement <br /> Time: Calculated purge: -f <br /> Time:. � �{(, �7 0 Actual purge: --^ <br /> Depth of well: Depth to water. 7L <br /> Depth to water: <br /> Start purge: A = V 91 Sampling time• S 5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> � r <br /> Sample appearance: �`�`� <br /> k: <br /> LocC� <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) :46, � <br /> Remarks: <br /> Signature: <br />