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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 1-20-16 <br /> Site: Beacon #474 Project No. : 94--474-01 <br /> 3440 E. Main Street Well Designation: MW-S <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 If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing risei7 (in inches) : / <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other /J-S06o,AeA- <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 Centrifugal pump <br /> Sampled with: Disposal bailer:Y Teflon bailer: <br /> Well Diameter: 211__�_ 4" 6" grr <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> AlkInitial Measurement Recharge Measurement <br /> ime: ti75 P Time: Calculated purge: �1 1 <br />_ Depth of well: Depth to water: 1) '3 Actual purge: q.l <br /> Depth to water: s 8'.i,r 11 <br /> Start purge: 1�_b3 —_ Sampling time: /J- <br /> Time <br /> LTime Temp. E.C. pH Turbidity Volume <br /> /L0 J <br /> 1.1-06 <br /> 244,57 <br /> I �3 <br /> Sample appearance: _ f 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 /> 41 Remarks: <br /> Signature: <br />