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1 r 1 <br /> DOULOS ENVIRONMENTAL COMPANY SAMPiING INFORMATION SHEET <br /> Client:-Ultramar Diamond Shamrock Sampling Date: 3 <br /> Site: Beacon 642 Project No. : 98643-01 <br /> _ _ 1210 East Hammer Lane Well Designation: W `_ <br /> Stockton, CA <br /> Is setup of traffic control devices required? CdM YES time; hours <br /> Is there standing water in well box? C= YES Above TOC Below TOC <br /> Is top of casing cut level? NO <:= If no, see remarks <br /> Is well cap sealed and locked? No CM If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UN 12" UV 12" EMCO_ 8"' BK_ <br /> 12" BK 12" DWP 121' CNI 36" CNI_ Other <br /> General condition of wellhead assembly: Excellent CC= 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: 2" 4"_ 611� 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement echar a Measurement <br /> Time: y: 4r Time: 57 : L{ Calculated purge: <br /> Depth of well: 7y' s© Depth to water: •2 ` Q Actual purge: <br /> Depth to water: <br /> Start purge: S a l Sampling time; 5! q l <br /> Time Temp. B.C. pH Turbidity Volume <br /> Z 3 • �' E'1�O • �� --- f <br /> S= <br /> s= 3 G'S e9 1:1 7 / 7 --- Y <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note candit on of replaced item <br /> 2" Locking Cap: Lock P3753: 7/32 Allenhead:� <br /> 4" Locking Cap; Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap:- Pinned Allenhead (DWP) : <br /> Remarks: <br /> ai rr,nature <br />