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DOULOS ENVIRONMENTA- COMPANY S,. -PLING INFORMATION SHEET <br /> Client: Ultramar _ Sampling Date: Z <br /> • Site: Beacon #474Project No. : 94- 474-01 <br /> 3440 E. Main Street Well Designation: MW42 <br /> - <br /> Stockton A <br /> Is setup of traffic control devices required. YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 2 <br /> Well cover type: 8" UV 12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI other-i2- P671EC� <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer x 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" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recha a Measurement r <br /> • Time: 7 3 Time: Calculated purge:� 1 <br /> Depth of well: 7 tPi 3 Depth to water: Actual purge: <br /> Depth to water: �� <br /> Start purge: / r 3 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Z S 7 <br /> Z5� �- <br /> �r = pis 0 ! Z <br /> 11 : q7 2 0 <br /> r <br /> Sample appearance: C Lock: <br /> Equipment replaced:- (Checkallthat 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 />