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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: , y_aQ -_ 26 <br /> Site: Beacon #474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation: MW-1 _ _ <br /> Stockton, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC 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) : <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other-44- <br /> General condition of wellhead assembly: Excellent oo 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: Disposal bailer:, Teflon bailer: <br /> Well Diameter: 2" 4" X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> initial Measurement Recharge Measurement <br /> Time: /)/0 Time: /1-51 Calculated purge: .1 <br /> Depth of well:_._ 94.-OS Depth to water: rJ Actual purge: ,1. <br /> Depth to water: 61110 <br /> Start purge: //30 _ Sampling time:J15� <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1 ��•L J /� 7� � <br /> 71-o <br /> 1 14, 9 11-74C1 2/q <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: 9/1.6 Bolt: <br /> 6" Locking Cap//: Pinned Allenhead (DWP) : <br /> Remarks: _ f� ? 11oln <br /> Signature: 'ti <br />