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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client - Ultramar Diamond Shamrock Sampling Date. 3 f <br /> Site : Beacon 0641 Project No. : 98-641-01 <br /> 210 East Hammer Lane Well Designation: V w <br /> Stockton CA <br /> is setup of traffic control devices required' YES time: hours <br /> Is there standing water in well box' �9YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no , see remarks <br /> Is well cap sealed and locked' N If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12 " BK 12" DWP ,1NI }� 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo 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: 291,2SI- 4" 6" Sol— <br /> Purge <br /> "Purge Vol . Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Initial MeasureMent Recharge Measurement y <br /> Time. 7 : ©% Time: 10 LV42 Calculated purge- <br /> Depth of well : ' ? Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge : 3 Sampling time:—/& <br /> Time Temp. E. C. pH Turbidity Volume <br /> 89 ^3 / 7 10 7 Y <br /> /0 = 3 S 7 3 �? s / <br /> /0r32 y v .23 <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: <br />