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'DOULOS ENVIRONMENTAL .OMPANY SAX SING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: � l Z <br /> Site: Beacon #641 Project No. : 98-641-01- <br /> 1210 East Hammer Lane Well Designation: <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> NO �� <br /> If no, see remarks <br /> Is tap of casing cut level? If no, see remarks <br /> is well cap sealed and locked? -t01 0 <br /> Height of well casing riser (in inches) : 12" EMCO 8" BK <br /> It BK__ <br /> cover type: 8" UV + � 12 3gn CNI�^ Other <br /> 12" BK{ 12" DWP CNI Excellent Good Fair Poor <br /> General condition of wellhead�ssembly: <br /> " disposable baler Submersible pump <br /> 2 <br /> Purging Equipment: �_Dedlcated bailer <br /> 211 PVC bailer Centrifugal pump <br /> 4" PVC bailer <br /> Sampled with: Disposable bailer: <br /> S Teflon bailer: <br /> Well Diameter: 211 X _ 4 611 Sol <br /> ---- <br /> Purge Vol. Multiplier: 0. 16 • <br /> 0.55 1.47 2 . 61 gal/ft. <br /> in_�t al Measurement Rechar a Measurement ur e: <br /> t � Calculated p 9 y—4' <br /> Time: 7- '� _ Time: G Actual Purge: f 4 1 <br /> Depth of well: S U Depth to water: • <br /> Depth to water: Z, Z <br /> Start purge:—I- Sampling time• �= <br /> Time Temp. E.C. <br /> pH Turbidity Volume <br /> ---------------- <br /> c� <br /> r D 4 -7 �- <br /> � <br /> Sample appearance: _ <br /> cic_ � Lock: <br /> ll that apply) Note condition of replaced item <br /> Equipment replaced: (Check a <br /> Lack #3753 :, 7/32 Allenhead: <br /> 2" Locking Cap:_, Lock-Dolphin: 9/16 Bolt:.- <br /> 4" Locking Cap: _ pinned Allenhead (DWP) :.�_ <br /> 6" Locking Cap:�� <br /> Remarks: <br /> Signature: <br />