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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> I -/0 - 9 <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation: MW-- 5 <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? NOES 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 12" UVZ__ 12" EMCO 8" BK <br /> 1211 BK 12" DWP 12" CNI 36" CNI they <br /> General condition of wellhead assembly: Excellent ood Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer >,7 centrifugal pump <br /> Sampled with: Disposal. bailer: � Teflon bailer: <br /> Well Diameter: 2" x 4" 611 $" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: 3 Time: = D Calculated purge: lS <br /> Depth of well: Depth to water: s �' 9� Actual purge: I S <br /> Depth to water: <br /> Start purge: S Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> ' F I <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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Z, <br /> Signature: <br /> // / �- <br />