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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> F Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon #641 _ Project No. : M98-641-01 <br /> 1210 East Hammer Lane Well Designation: MW-16 <br /> Stockton. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Qqq YES Above TOC Below TOC <br /> Is top of casing cut level? fM <GDIf no, see remarks <br /> Is well cap sealed and locked? NO <0E If no, see remarks <br /> Height of well casing riser (in inches) : /A <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 1" CNI�_ 36" CNI Qther <br /> General condition of wellhead assembly: Excellent Goo 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: -Y Teflon bailer: <br /> Well Diameter: 2" 1-Y 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: r � Time: 4 ,6r _ Calculated purge: <br /> Depth of well: 71 7� Depth to water: 4 2-6 Actual purge: /9.G <br /> Depth to water: L U <br /> Start purge: L5 ro Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> -� f <br /> L5 F a X_ r,,2 2 <br /> 301 <br /> Sample appearance: �„� .._ Lock: �f <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock x`3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />