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GDOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client _ Ultramar, Inc _ Sampling Date 6- 0 rO ( <br /> Site Beacon.6< '36141 Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation S <br /> Stockton CA <br /> Is setup of traffic control devices required? O YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is cop of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(m inches) `— <br /> Well co.er rype 8" or 12" UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12 'Chrisry 8"M&D 12"M&D 12"DWP <br /> 12" CNI I _ 12"Pomeco Other <br /> General condition of weTffihd assembly Excellent Goode Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4"PVC bailer - Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time : ©A— Time 0 Calculated purge 1 'L ` —7 <br /> Wepth <br /> epth of well - Depth to water e5 Actual purge to water p� / <br /> Start purge 6 y/ R_ Sampling time S 3 <br /> Time Temperature E C pH Turbidity Volume <br /> � 2 7 d 5 /0 2 l � • ;d <br /> / � d d /6 `� • �G <br /> 3, <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply) Note condition of rep aced 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 (DWT) <br /> �ernarks <br /> Signature <br />