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SAM ING INFORMATION SHEET <br /> DOULOS ENVIRONMENTAL COMPANY <br /> .7 _�f A <br /> Client: Ultramar Diamond Shamrock Sampling Date: <br /> r l <br /> Site: Beacon #641 Project No. : 98-641--01 <br /> 1210 East Hammer Lane Well Designation: <br /> Stockton CA <br /> hours <br /> Is setup of traffic control devices required? YES bove•TOC Below TOC <br /> Is there standing water in well box. NO � If no, see remarks <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? 10 0 <br /> Height of well casing riser (in inches) . 12n EMCO 81' BIC <br /> it _ <br /> Well cover type: 8" UV�^� lx 3611 CNI Other <br /> 12" BK 1211 DWP CNI�— Fair Poor <br /> General condition of wellhead Xssembly: Excellent <br /> 2tt disposable bailer _Submersible pump <br /> Purging Equipment: 211 pVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: <br /> �P Teflon bailer• <br /> Well Diameter: 211.2�L 411 611 all <br /> 0. 65 1.47 2 . 61 gal/ft. <br /> Purge Vol. Multiplier: 0. 16 `,`3 <br /> t Measu eme t Bec <br /> har a measurementCalculated purges <br /> Time: �= � <br /> Time: f S Depth to w ter: 2 ' Actual Purge: <br /> Depth of well: 0 <br /> Depth to water: <br /> Start purge:--2L- <br /> Sampling time <br /> Time Temp. E.C. <br /> PH Turbidity Volume <br /> '7 � 3 7 6S• � <br /> =39 4r - 7 Igo -7 - s / <br /> 7. 4 G6 • a 2 Y69 2- `f <br /> : <br /> Lock: <br /> Sample appearance <br /> condition of replaced item <br /> Equipment replaced: (Check all that apply) Note con7/32 Allenhead• <br /> 211 Locking Cap:..�,� Lock ,13753 : 9/16 Bolt: <br /> .,^. <br /> 4" Locking Cap:�� Lock-Dolphin:r..� <br /> 611 Locking Cap:_ <br /> Pinned Allenhead (DWP) <br /> Remarks: <br /> Signature: <br />