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` DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_ Ultramar Sampling Date: <br /> Site: Beacon 419 Project No. : 94-419--001 <br /> 2350 Waterloo Road Well Designation: MW- <br /> Stockton, CA <br /> Is setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box? CMff!5 YES Above TOC Below TOC <br /> Is top of casing cut level? NO 4FER If no, see remarks <br /> Is well cap sealed and locked? NO 3xM If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 W 12" LTV 12" EMCO S" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other. /'L ��co <br /> General condition of wellhead assembly: Excellent c Fair Poor <br /> Purging Equipment: 2" disposable bailer r„• _ Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S %o Teflon bailer: <br /> Well Diameter: 2" 4"K 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial tleasuregment echarge Measurement G y <br /> Time: = 3 Time: • ! 1 Calculated purge: <br /> Depth of well: �S ' Z y Depth to water: 3 4 Actual purge: <br /> Depth to water: ;1/ 33 <br /> Start purge: � _ Sampling time: + <br /> Time Temp. E.C. pH Turbidity Volume <br /> 9: /0 G 7 . /o9 7 - sl ----------- <br /> Sample <br /> -----�Sample appearance: Lock: G iZ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: . 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Sianature: <br />