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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET " <br /> Client: Ultramar Sampling Date: 3 `31`1 <br /> Site: Beacon • 474 Project No. :-. 94-474-.01 <br /> 3440 E. Main Street Well Designation: MW- )-A <br /> Stockton. CA <br /> Is setup of traffic control devices required? SNO YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO E 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: 811 UV1211 UV 12f1 EMCO 811 BK <br /> 121' BK 1211 DWP 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2}1 4116" 8t1 <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 6, €.fes Time: I U 7 _. Calculated purge: <br /> Depth of well: ;h- 71! Depth to water: ?..o Actual Purge: J `1, <br /> Depth to water: 61. 4� T <br /> Start purge: R 3 a Sampling time: C <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2- <br /> cif /; <br /> Sample appearance: Lock: !B- <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 1r Allenhead: <br /> Lock 3753 • <br /> 7 32 <br /> 2 Locking Cap: # / <br /> 1r 9 16 Bolt: <br /> Lock-Dolphin:4 Locking Cap: p / <br /> 6!1 Locking Cap: Pinned Allenhead (DWP) : - <br /> Remarks: <br /> f k <br /> i <br /> Signature: �" <br />