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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:, <br /> Site: Beacon #610 Project No. : 94-610-01 <br /> 3300 Waterloo Road Well Designation: MW- S <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? NOIf 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: 8111 UV 1211 UV1211 EMCO 811 BK <br /> 1211 BK 1201 DWP 1211 CNI 3611 CNI Other 1 t r 1001�[V <br /> General condition of wellhead assembly: Excellent eCoug> Fair Poor <br /> Purging Equipment: 211 disposable bailer X,Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: f Teflon bailer: <br /> Well Diameter: 211 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 111,. 2 3 Time: Calculated purge: <br /> Depth of well: 89. 3 9 Depth to water: 0 Actual purge: 13 <br /> Depth to water:- 3 7 1 __ <br /> Start purge: Sampling time: L3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> • I0 4�; _ 6 v 9'0 1 <br /> I6. L6 63 . c7 'tfeY ' 1q 3 <br /> 2 • 0 `7 t S ---- y <br /> Sample appearance: Lock: 3 75 3 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />