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DOULOS ENVIRONMENTAL }COMPANY Se-.PLING INFORMATION SHEET <br /> Client: Ultramar _ Sampling Date: 12- / tlb <br /> Site: Beacon J474 Project No. : 94-474-01 <br /> ___ 3440 E. Main Street Well Designation: KW_ <br /> Stockton, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y 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) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good 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:-X- Teflon bailer: <br /> Well Diameter: 2" 411 X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> • <br /> Time: -. 1 3 Time: d Calculated purge: � q ��,�,� <br /> Depth of well: (o Depth to water: 7 Actual purge: <br /> Depth to water: p <br /> Start purge: ?� ' S Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> =3 0 �79 t9 ti 07 � -7, 1. 2. � <br /> 10 �4 7, 2. <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 />