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' DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 7 ! <br /> Site: Beacon #419 Project No. : 94-419-01 <br /> 2350 Waterloo Road Well Designation: MW-- 5 <br /> Stockton CA <br /> Is setup of traffic control devices required? (96�' YES time: hours <br /> Is there standing water in well box? (5j-0> Y Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked' NOII(�� If no, see remarks <br /> Height of well casing riser (in inches) : 9 <br /> Well cover type: 8" W 12" UV 12" EMCO _FZ'_ 8" BK <br /> 1211 BK 12" DWP 12" CNI 36" CNI nther <br /> General condition of wellhead assembly: Excellent Good 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: ?G 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 /> Initial Measurement Recharge Measurement <br />*Time: Time: ' O 3 Calculated purge: <br /> Depth of well fv �, �_ Depth to water: Actual purge: <br /> Depth to water: .S(o . L,5 <br /> Start purge: 1Z L+7 Sampling time: D <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2 S z 70 1 - Z <br /> `3t5- f+ 7 69 ? 3 <br /> o 0 7 , _7 5- Lf 9 (0 q f --- - �- <br /> Sample appearance: Lock: 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: 1� Pinned Allenhead (DWP) : <br /> Remarks : "t <br /> Signature: Ila <br />