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I • <br /> 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: MW- <br /> Stockton CA <br /> Is setup of traffic control devices required? (R-0 YES time: <br /> hours <br /> Is there standing water in well box? NO " Kl_�OVe T5C Be ow TOC <br /> Is top Of casing cut level? NO A--F$ 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: W 12" W� 12" EMCO 8" BK <br /> 12" BK " DWP 12" CNI 36n CNI Other <br /> General condition of wellhead assembly: Excellent C 0 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible. pump <br /> 2 PVC bailer <br /> Dedicated bailer <br /> 4" PVC bailer - ,Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 2" 4" 6" $„ <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal./ft. <br /> Initial Measurement Recharge Measurement <br /> Time:—_?19 Time: fWJ Calculatedur e: 3, <br /> Depth of well: f•� Depth to water: hS ..{ > Actual purge 3 <br /> Depth to water:_ S .�]_ <br /> Start purge: Sampling time:Ca ) <br /> Time Temp. E.C. jpH Turbidity Volume <br /> el L1 <br /> Sample appearance: 1z<.r Lock: Q l <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 />