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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: c_�- C <br /> Site: Beacon #474 Project No. : 94--474-01 <br /> 3440 E. Main Street Well Designation: MW- o� <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? CW Y S Above TOC Below TOC <br /> Is top of casing cut level? NO ES 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" UV 1211 UV 12" EMCO 8I�' K <br /> 12" BK 12" DWP 12" CNI 36" CNI Other p2 Off_ C(D <br /> General condition of wellhead assembly: Excellent o 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: 211 411 6n 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Rec ar e Measurement <br /> Time: = _% Time: Calculated purge: 7 <br /> Depth of well: '7 Depth to water: s 9 l Actual purge: <br /> Depth to water: �9 <br /> Start purge: 1 = / y Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> J <br /> ID = 2- 7d- c< IP —7- '30 <br /> f <br /> Sample appearance : <br /> - = 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 /> - <br />