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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: -2d-y�_ _ _ <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? M YES Above TOC Below TOC <br /> Is top of casing cut level? _ YES If no, see remarks <br /> Is well cap sealed and locked? NO YES If no, see remarks <br /> Height of well casing risen (in inches) : d.- <br /> Well cover type: 8" UV 12" UV_,�'_ 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI they ' <br /> General condition of wellhead assembly: Excellent and Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer et 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 /> AlLinitial Measurement Recharge Measurement <br /> 'WFTime h J-.1 — Time:, O Calculated purge: S <br /> Depth of well: ?J/5' Depth to water: Actual Actual purge: 53 s <br /> Depth to water• o .?7 <br /> Start purge: /�2-y 7 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> -2-7 3 <br /> Li <br /> Sample appearance: Lock: <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: 4 0 pP <br /> Signature: <br />