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• DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date 3.3-,25-4767 <br /> . Site: Beacon #610 _ Pro3ect No. : 94-610-01 <br /> 3300 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? <EW 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: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 361' 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 S P Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 11-1-10 — Time: if:/ Calculated purge: <br /> Depth of well: 6.7-4.- Depth to water:- 3�' Actual purge: 6C <br /> Depth to water: 37- 9S <br /> Start purge: 5�-- Sampling time: <br /> r <br /> Time Temp. E.C. pH Turbidity Volume <br /> =s 6 7 .50 <br /> q-.00 2 • a o o 7 q �• ,.� <br /> - �0 6t S 3 ?_N <br /> Sample appearance: a✓li 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 /> Signature: <br />