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DOULOS ENVIRONMENTA_ }COMPANY Sz. 2LING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 12-tl t'0 <br /> iSite:—Beacon #474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation:_ MW- C� <br /> Stockton A <br /> Is setup of traffic control devices required YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? O e M If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: s" UV 1,2" UV 12" EMCO 8" $,K <br /> 12" BK 12" DWP 12" CNI 36" CNI Other 1 '2-1 <br /> General condition of wellhead assembly: Excellent 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:s"rp Teflon bailer: <br /> Well Diameter: 2" 4" X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measureme t echarg!t Measurement l <br /> • Time: , LTime: l Calculated purge: 5�2�0 'f <br /> Depth of well: 7(p 15_ Depth to water: Actual purge:S Za J f <br /> Depth to water:_574!, �::7 <br /> Start purge: ` .2 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> /0 3; 7 -----� Z <br /> 3 7 . 5 7, 37 -; <br /> Sample appearance: Lock: <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 />