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DOIILOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #474 Project No. : 94-474-01 - <br /> 3440 E. Main Street Well Designation: _ MW- a A . <br /> .i <br /> Stockton, CA <br /> Is setup of traffic control devices required? qN <br /> YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? E If no, see remarks <br /> Is well cap sealed and locked? NO If no, sere remarks <br /> Height of well casing riser (in inches) : <br /> } Well cover type: 8" UV 12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other /)-`A s-� a.-,�2 <br /> General condition of wellhead assembly: ExcellentGoo Fair Poor <br /> Purging Equipment: _� ' disposable bailer Submersible pump <br /> 211 -PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> ,R <br /> } <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> .'rime: 7 u Time: 110 / Calculated purge: L <br /> Depth of we'll 76 7 Depth to water: GrS,Y, 6 Actual purge: Z_A,q 7 <br /> Depth to water: 6 <br /> F Start purge: EL d Sampling time: 10 'L <br /> Time Temp. E.C. pH Turbidity Volume <br /> I <br /> �- 730 /340 Xf l <br /> �46' 74 z 14-6 751 <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 /> f <br /> Remarks: <br /> Signature: ��� <br />