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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Dater <br /> Site:, Beacon X474 _ 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? IR YES Above TOC Below TOC <br /> Is top of casing cut level? N-6 If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 10 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI her ii a-•. .P�,� <br /> General condition of wellhead assembly: Excellent o 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" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. it <br /> Initial Measurement Recharge Measurement <br /> Time: koff Time: M , 40 Calculated purge: <br /> Depth of well _74-27 _ Depth to water: <?q ' 39 Actual purge: <br /> Depth to water: ;_meq <br /> Start purge: 10Q3 Sampling time: I D y�- <br /> Time Temp. k E.C. pH Turbidity Volume �I <br /> I <br /> 75-1I r. <br /> -71- 3 -714� ��11 <br /> -_7 3 Y <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 : <br /> Signature: <br />