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L <br /> T <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> I <br /> Site: Beacon 4474 Project No.: 94-474-01 <br /> 3440 E. Main Street Well Designation: —MW- <br /> Stockton—CA <br /> W-StocktonCA ! <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? <br /> NO If no,scc remarks I <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"W 12"W 12" EMCO 8"BK <br /> Other�1 <br /> 12" BK 12"DPW 12" CNI 36" CNI <br /> 1 <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 3"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> i <br /> Well diameter. 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 ga1fR <br /> Initial Measurement e Mcasmmlent <br /> Time: 9 1 Ll Time:fQL12 Calculated purge: <br /> i <br /> Depth of well: Depth to water Aotual purge: 3 �� <br /> Depth ao water: <br /> i <br /> Start purge: _ In Q Sampling time: I&Q7 <br /> i <br /> Time Temperature >E. C. pH Turbidity Voh= <br /> e)L4 731 <br /> 7 7d 7 <br /> 1 <br /> Sample appearance: per' Lock <br /> i <br /> l..quiprttcnt replaced (Check all that apply) Dote condition of replaced items <br /> 2" locking cap: Lock 43753: 7132 A1lcnhcad: <br /> 4. locking cap: Lock-Dolphin: � 9116 bolt: � <br /> 6" locking cap: Pinned Allcnhcad(DPW): <br /> Remarks. <br /> Signature -- <br />