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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• Ultramar Sampling Date• _ 3 !- q <br /> Site: Beacon #419 <br /> Project No. : 9 -4 <br /> 2350 0o Road well Designation: HE- <br /> Stockton, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standingwater in well box? M YES Above TOC Below TOC <br /> ? NO ® If no, see remarks <br /> Is top of casing cut level. � NO If no, see remarks <br /> Is well cap sealed and locked. y <br /> Height of well casing riser (in inches) : 12" EMCO gg" <br /> Well cover type: B" UV 12 91 W----- �' /P Pow Ew C 0 <br /> 12" BK 12" DWP�,- 12" CNI 36" CNI��,,. Other <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> _ <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:-P Teflon bailer: <br /> Well Diameter: 2" <br /> 4" ( 6't_ <br /> 8�� <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial easu ement Recharge measurement <br /> Z <br /> Time: Calculated purge:-5 /4 <br /> Time: 74Depth of well. �S U 3 Depth to water:_ ` ' Actual purge: 7.101 <br /> Depth to water: Y 4 <br /> O r Sampling Start Furge: / � _ p g time: // <br /> Time Temp. E. C. pH Turbidity Volume <br /> D _� <br /> � J <br /> Sample appearance: l �� r" Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 :.— 7/32 Allenhead:� <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt. <br /> 6" Locking Cap:w _ Pinned Allenhead (DWP) :� <br /> Remarks: <br /> Signature: <br />