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DOQLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <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? 2 ove C Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : __10 <br /> Well cover type: 8" W 12" UV X 12" EMCO 8" BK <br /> 12" BK 12" DWP 1.2" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer a�Centrifugal pump <br /> Sampled with: Disposal 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 /> Initial Measurement Recharge Measurement <br /> Time: /ai-7 Time:_ /JIG _ Calculated purge: 10.6614 <br /> Depth of well :-- {3.52:_ Depth to water:_ 5 7. 5 L Actual purge: /0 r, <br /> Depth to water:_ --7.O5 <br /> Start purge: '117 Sampling time: Z/ '3 7 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1130 6 ZJ lio -7.2- 1 <br /> 1I � 67_d /05 Z <br /> Sample appearance: _ � Lock: _ r _ <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 /> Signature: 2111--tJ VZIOL-e� <br />