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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: /1--g-16 <br /> Site: Beacon #474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation: MW- <br /> Stockton, CA -- = <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) . /J__ M _", <br /> Well cover type: 8" UV 12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 35" CNx Other ` <br /> General condition of wellhead assembly: Excellent qb:� Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sa6mpled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" x 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> . Initial Measurement Recharge Measurement <br /> Time: I0�L4 Time: //ii Calculated purge: 9 9s.J <br /> Depth of well. 5-J_ Depth to water:G7. '91 Actual purge:10 <br /> Depth to water: _O& <br /> Start purge: 11/.3 Sampling time: /! <br /> Time Temp. E.C. pH Turbidity Volume <br /> P/4 9.), <br /> 12Sample appearance: r1ilLock: <br /> Equipment replaced: . (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : - <br /> Remarks: <br /> - i <br /> Signature: ` <br />