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3 r � <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Diamond Shamrock Sampling Date: -3 4_ <br /> Site: Beacon 641 Project No. : 98-641-01 <br /> 1210 East Hammer Lane Well Designation:/11"" — <br /> Stockton CA <br /> Is setup of traffic control devices required? (:; YES time: hours <br /> Is there standing water in well box? CJD� YES Above TOC Below TOC <br /> Is top of casing cut level? NO C2=) If no, see remarks <br /> is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK_ 12" DWP 120 CNI 3 6" CNI______ Other ! Z r' " D <br /> General condition of wellhead assembly: Excellent 2= 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: • <br /> Teflon bailer. <br /> Well Diameter: 2" 4"� 611 g.. <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2. 61 gal/ft. <br /> JnitLal, Measurement Recharge Me surement <br /> Time: swvZ Time: 45 Calculated purge:. -VT 7 <br /> Depth of we11:^ � '4-0 Depth to water: 3 g Q Actual purge: <br /> Depth to water: <br /> Start purge: O Sampling time: 6 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> [6 : <br /> = Z$ 45S • 7 4 ,19 -7 X 1 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced ite <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 /> r <br /> �{r�nAture: <br />