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` DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: -7- -2, r 4 6 <br /> Site: _Beacon #419 _ Project No. : 94-419-01 <br /> 2350 Waterloo Road Well Designation: MW- �} <br /> Stockton, CA <br /> Is setup of traffic control devices required?�]R YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked' NO YE If no, see remarks <br /> Height of well casing riser (in inches) : � <br /> Well cover type: 8" UV 12" UV 12" EMCO X 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent ood Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _ X Centrifugal pump <br /> Sampled with: Disposable bailer: X Teflon bailer: <br /> Well Diameter: 2" 4"-_ 6" all <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ' 15 Time: 1 -2- , Calculated purge: Z� aJ�t <br /> Depth of well.. (0 -71 6 _5 Depth to water: 5 b Actual purge• qq <br /> Depth to water: S (o , 2-b <br /> �1 <br /> Start purge: Z } (o Sampling time: Z 4 <br /> Time Temp. E. C. pH Turbidity Volume <br /> ( 12- 1 . b I b4q �og0 <br /> 2 "Z5 to -7 _z_ <br /> � 17",3( 0 3 <br /> tiz`37 z 1677 � 7 � `�- <br /> Sample appearance: G 'j V. Lock: _ �_ -7 5 3 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />. Remarks: p 1'ti1 <br /> Signature: '� <br />