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DOULOa ENVIRONMENTAL .OMPANY SAr SING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> Site: Beacon t641 Project No. : 98-641-01 - <br /> 1210 <br /> 8-641-01 _12 0 East Hammer Lane Well Designation: w <br /> Stockton CA <br /> Is setup of traffic control devices required? (,W YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked) NO -S If no, see remarks <br /> Height of well casing riser (in inches) : <br /> b <br /> Well cover type: 8" UV_ 12" UV 12" EMCO 8" BKS <br /> ] `rCNI�_ " Other <br /> 12" BK 12" DWP Excellent�� Fair Poor <br /> General condition of wellhead�ssembly: <br /> • 21' disposable bailer � Submersible pump <br /> Purging Equipment. ^--2,1 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" \/1 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> 't a Measu eme t Recharge Measurement g a <br /> purge.— <br /> Time: o Time: Calculated purge.— <br /> DS Depth to water: O Actual purge:_Z:- <br /> Depth of well: P <br /> Depth to water: L. <br /> Start purge: 5 v Sampling time: <br /> s; n <br /> Time Temp. E.C. pH Turbidity Volume <br /> lo4to -7,34 2- <br /> S _ If 107 <br /> Sample appearance: Lock: L--� <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 • 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: - _ _ Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />