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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> J <br /> Sampling ling Date: 3 <br /> Client: Ultramar <br /> Project No. : 94-419--01 <br /> Site: Beacon4 9 <br /> 2350 Wate loo Road Well Designation: AM V-t—V- <br /> Stockton. CA <br /> Is setup of traffic control devices required? (:2p <br /> 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: 811 UV 1211 UV 121' EMCO $" BK�_�o� <br /> 12" BK 1,21f DWP 12" CNI 3601 CNI- Other <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"_ 411 6If 811 <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> initial Measurement echar a Measu ement S <br /> Time: d Time: Calculated purge: <br /> .3 s o water: - G Actual purge: <br /> Depth of well. Depth t <br /> y� <br /> Depth to water: <br /> Start purge: Sampling time: S <br /> Time Temp. E.C. pH Turbidity Volume <br /> IP 41 7 d <br /> 7 -7- Ll <br /> -7. o �. <br /> Sample appearance: 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 />