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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:- Ultramar Diamond Shamrock Sampling Date: <br /> Site:-- Beacon 0641 _ _ _ Project No. : 98-641-01 <br /> � 1210 East _Hammer Lane Well Designation: <br /> Stockton, _gA� <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? O- If no, see remarks <br /> Is well cap sealed and locked? - NO If no, see remarks <br /> Height of well casing riser (in inches) : f-L <br /> Well cover type: 8" UV 121' UV 12" EMCO 8" BK <br /> 12" BK_ 12" DWP '.;'2tYCNI36" CNT Other <br /> General condition of wellhead assembly: Excellent Chi Fair Poor <br /> Purging Equipment: _2" disposable bailer X- Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> Orr PVC bailer S P Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> InWg]Leasurement EechaKge Measurement Z f <br /> Time: S:o•��_ Time: : Calculated purge: <br /> Depth of well: �.3•� Depth to water: L•/d Actual purge: <br /> Depth to water: W- '/7 <br /> Start purge: Sampling time:- <br /> Time Temp. E.C. pH Turbidity Volume <br /> =SD 6 2 • � I t G / � •�� �--- Z <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition 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 /> E��riature: <br />