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DOTJLOB ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:-- .Ultramar Sampling Date: 3 <br /> Site: Beacon J419 Project No. : 94-419-01 <br /> 2350 Waterloo Road Well Designation:_ MW_ <br /> Stockton, CA <br /> Is setup of traffic control devices required? <EaP YES time: hours <br /> Is there standing water in well box? <ZIET:) YES Above TOC Below TOC <br /> is top of casing cut level? NOif no, see remarks <br /> Is well cap sealed and locked' NO � If no, see remarks <br /> Height of well casing riser (in inches) : 12„ EMCO $" BR <br /> Well cover type: 8" W 12" UV <br /> 12" BK 12" DWP 12" CNI 36" CNI^�. Other 1 <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" 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 /> 4" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> 'Initial Measurement echar a Measurement <br /> Time: -1 ' d 7 Time: Calculated purge: �' <br /> Depth of well: 2 Depth to water: � 0 Actual purge: <br /> Depth to water: • � <br /> Start purge: 1� - �- Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: <br /> 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: Pinned Allenhead (DWP) : <br /> Remarks: <br />