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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> " 3 - � <br /> Client:_ Ultramar _ Sampling Date: 2 <br /> 0 Site: Beacon 1419 _ _ _ Project No. :,24 4.19`01 <br /> 2 0 Waterloo Road 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? YES Above TOC Below TOC <br /> Is top of casing cut level? No < 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" W 12" EHCO 8" BK <br /> 12" BK— 12" DWP 12" CNI 36" CNI other <br /> General condition of wellhead assembly: Excellentr Fair Poor <br /> - ffdXEMEWWWN0W� <br /> Purging Equipment: 2" disposable bailer ]LC- -Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:--LP—P Teflon bailer: <br /> Well Diameter: 2" 4",„X-- 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> JniXial Measurement e e e su es e t <br /> Time: 6": 3 d�? .� Time: ,-7 ' /_ Calculated purge: 2.q <br /> Depth of well: Depth to water:, Z `6 0 Actual purge: • of <br /> Depth to water: <br /> Start purge: - qo sampling time: S _ <br /> Time Temp, E.C. pH Turbidity Volume <br /> 7 -3 2- <br /> 14 <br /> Sample appearance: Lock: r <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--Dolphins: 9/16 Bolt:,�____,�__ <br /> 6" Locking Cap: Pinned Allenhead (DWP) :� <br /> Remarks: <br />