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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br />Client:_ Ultramar, Sampling Date: -r -.L9 -q5 <br />Site: BeAcon 1610Project No.: 24-61Q-01 <br />3300 <br />-61 - <br />3300 Waterloo Road Well Designation: MW -3 _ <br />Stockton. CA <br />Is setup of traffic control devices required? YES time: <br />Is there standing water in well box? W YES Above TOC <br />Is top of casing cut level? <br />Is well cap sealed and locked? <br />Height of well casing riser (in inches): <br />Well cover type: 8" UV 12" UV_ <br />12" BK 12" DWP 12" CNI <br />General condition of wellhead assembly: <br />_ hours <br />Below TOC <br />N,Oj Y ) If no, see remarks <br />NO 'SIf no, see remarks <br />i-6 <br />12" EMCO <br />36" CNI her <br />Excellent(Co od <br />S" BK <br />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" 4104 6" all <br />Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br />•Initial Measurement Recharge Measurement <br />Time: ?/e Time: 16SCalculated purge: <br />Depth of well: 61.AJ . Depth to water:_ Actual purge: P"•6 h <br />Depth to water: �A61 <br />Start purge: 1000 Sampling time: /10j) <br />Time <br />Temp. <br />E.C. <br />pH <br />Turbidity <br />Volume <br />r �o <br />$1 <br />;-- <br />X01 <br />e)6 <br />e l7 <br />73- <br />3 <br />t 01ro <br />� <br />61 0 <br />7� � <br />Sample appearance: Lock: <br />r <br />■ �wwww�i w•�w <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 />