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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 9-.10-914 <br /> Site: Beacon 1474 Project No. : 94-474-01 <br /> 3440 East Main Street Well Designation: MW- <br /> Stockton, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? I YES Above TOC Below TOC <br /> Is top of casing cut level? NO <:�B If no, see remarks <br /> Is well cap sealed and locked? NO (Zp If no, see remarks <br /> Height of well casing riser (in inches) : LIC <br /> Well cover type:- 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNItether /,"- <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: Disposal bailer:_,)( Teflon bailer: <br /> Well Diameter: 2" 411_X'_ 611 Sit <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> ime: 33 1 Time: Lha Calculated purge: l <br /> epth of well: �SR.3� Depth to water: �o.SD Actual purge: <br /> Depth to water:_7!t53 <br /> Start purge: Ild00 Sampling time: 0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 05 14 <br /> Lf 10 77. )- � 1V 7g�- 2 <br /> r� 1S 17. 0 X30 7. U- <br /> S 71 7 )-q -------- <br /> Sample appearance: � ` _ Lock: <br /> ��.un�i i��uninr — - - ■ i iui moi■ ��w <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: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />