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POULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client _ Ultramar, Inc Sampling Date 6"— /? —0 <br /> Site Beacon jW 3 641 Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation —,Ael_w <br /> Stockton, CA <br /> Is serup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut lever NO If no, see remarks <br /> Is well cap sealed and locked? NO cyw If no,see remarks <br /> Hesghi of well casing riser(ui inches) 1 <br /> Well coyer type 8" or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12 ' Chrtsry8" &D 12"M&D 12"DWP <br /> 12 'CNI /3NI_� 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer —X Centnfugal pump <br /> Sampled with Disposable bailer--- - Teflon bailer Disposable Tubing <br /> Well Diameter 2" X 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time G " ©X _ Time !F , <br /> Q Calculated purge �L I <br /> !Depth of well 7 3 Depth to water 21"0 Actual purge <br /> Depth to water _ �!�L�� <br /> Start purge O Sampling time ? :/0 <br /> Time Temperature E C pH Turbidity Volume <br /> G . o 2 - / IACD -7 -5o <br /> ^ C9 -7 • <br /> 7 Yo <br /> OeE— quo 7 <br /> Sample appearance �c�_ Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks <br /> Signature <br />