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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br />Client: Ultramar Sampling Date: T -J. 6-q3 <br />iSite: Beacon 1614 _ Project No.: 94-614-01 <br />3300 Waterloo Road Well Designation: MW -5 <br />Stockton CA <br />Is setup of traffic control devices required? YES time: <br />Is there standing water in well box? 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 cov@r type: 811 UV 12" UV <br />12" BK ,i_ 12" DWP 12" CNI <br />General condition of wellhead assembly: <br />_ hours <br />Below TOC <br />O If no, see remarks <br />NO If no, see remarks <br />_ 12" EMCO <br />36" CNI <br />Excellent 00 <br />8" BK <br />r <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" 6" $" <br />Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br />Initial Measurement Recharae Measurement <br />Time: 5 Time:,. Calculated purge: d <br />Depth of well: '?4714:r Depth to water. S&76.2- Actual purge: 21.1 1 <br />Depth to water: 54 9J <br />Start purge: i(-1 I Sampling time: 2 oO <br />Time <br />Temp. <br />E.C. <br />pH <br />Turbidity <br />Volume <br />73 <br />4g5 <br />72-5 <br />--J <br />Sample appearance: 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: Y&I <br />