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DOULOS 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: <br /> 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? - NO E 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" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Otherf_j-'PnmA,5& <br /> General condition of wellhead assembly: Excellent 70_04 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: A/ Teflon bailer: <br /> Well Diameter: 2" - 4"J(__ 6+1 g if <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> • Time: 8/9 Time: z o _ �_ Calculated purge- �.s <br /> Depth of well:_ Depth to water: �•3 6 Actual purge; 1.5 <br /> Depth to water:-62, 61 <br /> Start purge:/3 Sampling time: 2- 06 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3C, <br /> 70 2 <br /> 3 <br /> Sample appearance: _ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item - <br /> 211 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: <br />