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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: _? -1-5-`f� <br /> Site: Beacon #610 - Project 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? YES Above TOC Below TOC <br /> Is top of casing cut level? NO gf= If no, see remarks <br /> Is well cap sealed and locked? NO (InP If no, see remarks <br /> Height of well casing riser (in inches) : .30 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" 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", 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: 2' 0 Time: . Calculated purge: <br /> Depth of we 11: sS` Depth to water: 3�' I d Actual purge: O <br /> Depth to water: <br /> Start purge: 3 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2,: ,3 f 3 - ) S fl o I <br /> 3 3 6 - 6 •g g 2- <br /> Sample <br /> Sample appearance: Lock: P4 "�— <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: <br /> Signature: <br />