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4 a <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond- Shamrock Sampling Dater <br /> Site: Beacon 641 Project No. ; g8-641-01 <br /> _ <br /> 1210 East Hammer Lane Well Designation: / <br /> Stockton, C <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 /> Is top of casing cut level? NO <IMP If no, see remarks <br /> Is well cap sealed and locked? NOIf no, see remarks <br /> Height of well casing riser (in inches) : 7�.J <br /> Well cover type: 8" UV12" UV12 f' EMCO 8" K <br /> 12" BKS_ 12" OWP 12" CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent = Fair poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _ bC _Centrifugal pump <br /> Sampled with: Disposable bailer:_ Teflon bailer: <br /> Well Diameter: 2"_ 4fi dfi 1301 <br /> Purge Vol. Multiplier: O. 16 0.65 1.47 2 . 61 gal/ft. <br /> XnJt A' easurgme t Recharge Measurement � _� <br /> Time: y=S 7/ g I Time: = Calculated purge: <br /> Depth of well: Depth to wat, Actual purge: <br /> Depth to water: y �6' <br /> Start purge: L7 Sampling time: 057 <br /> =CK:7 <br /> Time Temp. E.C. pH Turbidity volume <br /> S ? 33 -7 .a <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condit!on 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 /> 1 <br /> a4""Ature: <br />