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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ` Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon #641 Project No. : 9 8641-01 <br /> 1210 East Hammer Lane Well Designation: <br /> Stockton, CA <br /> � <br /> Is setup of traffic control devices'required. � YES time:. hours <br /> YES Above TOC Below 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? NO <br /> Height of well casing riser (in inches) : -12uher <br /> lEMCo__� S„ BK_�_ <br /> Well cover t pe: 8" W_ 12 W <br /> 361t CNI <br /> 12" BK y32" DWP 12" seemCNI Excellent Fair Poor <br /> General condition of wellhead assembly: <br /> Purging Equipment: 2" Submersible pump disposable bailer Dedicated bailer <br /> 4 I PVC bailer - <br /> 2" PVC bailer ��Centrifugal pump <br /> -- <br /> Sampled with: Disposable bailer: <br /> Teflon bailer:.._. <br /> Well Diameter: 2" <br /> 411 611 819 <br /> - <br /> Purge Vol. Multiplier: 0. 16 <br /> 0. 65 1. 47 2 . 61 gal/ft. <br /> i 'a Measu ement Rechar Measurement <br /> Time: _ Calculated purge: <br /> Time: -7 Y - ,2 Depth to water: A- �� Actual purge: <br /> Depth of 'well: p <br /> Depth to water: V6 T4 <br /> Start purge: <br /> Sampling time: <br /> Time Temp. <br /> E. C. pH Turbidity Volume <br /> 3 � <br /> 2 leg /D '7- 7- D <br /> -, r 7 � -7 , 3 <br /> �Q0 7l7 <br /> Sample appearance: <br /> / Lock: <br /> Equipment replaced: (Check all that apply) Note con7/32 <br /> replaced item <br /> 2 All <br /> 2" Locking Cap: Lock 03753 :__ 9/16 <br /> �_ Lock-Dolphin: <br /> 9/16 Bolt: <br /> A Locking Cap: pinned Allenhead (DWP) : <br /> 6" Locking Cap: <br /> Remarks: <br /> Signature: ' <br />