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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3 <br /> Site:—Beacon 4 9 Project No. : 94-419-01 -.- <br /> 2350 <br /> 4-•419-032 50 Waterloo Road Well Designation: MW- 3 <br /> Stockton CA <br /> Is setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box? C� Y S Above TOC Below TOC <br /> Is top of casing cut level? NO if no, see remarks <br /> Is well cap sealed and locked. No <br /> If no, see remarks <br /> Height of well casing riser (in inches) : - — <br /> Well cover type: 8" W 12" W 12" EMCO 8„ BK <br /> 12” BK— 121t DWP� 44CNI 36" CNI Other <br /> General condition of wellhead�"assembly: Excellent �o Fair Poor <br /> Purging Equipment: X211 disposable bailer Submersible pump <br /> 2 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:! Teflon bailer: <br /> Well Diameter: 2" <br /> Purge Vol. Multiplier: 0. 16 <br /> 0. 65 1.47 2 . 61 gal/ft. <br /> Measurement ec a e Me aurement <br /> Timtial e: Time: Calculated purge: � r1 • S may' <br /> / e: to water. 3 to Actual purge:E <br /> Depth of well. y 7 Dep <br /> Depth to water: t Z6 <br /> Start purge: • � Sampling time: <br /> ' y3 <br /> Time Temp. <br /> E.C. EpH Turbidity Volume <br /> 2 G •�� <br /> If <br /> � 2el1 -7 •V6 3 <br /> Sample appearance: <br /> Lock: ie <br /> Equipment replaced: (Check all that apply) Note conditio of replaced item <br /> x" Locking Cap: Lock 13753 : 7/32 Allenhead:l_ <br /> 4" Locking Cap: Lock-Dolphin-r 9/16 Bolt., <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> is P <br /> 410011e�W_ <br />