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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> . Client: Ultramar Sampling Date: 3- 13 <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? �fCY YES time: ho s <br /> Is there standing water in well box? NO (YE Above TOC slow�oc <br /> Is top of casing cut level? N4 (Y If no, see r arks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> " <br /> Height of well casing riser (in inches '�� <br /> Well cover type: 8UV 12" W 12" EMCO 811 BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo 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" 4 611 <br /> 811 <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> OInitial Measurement Recharge Measurement <br /> Time: )-6 Time: -111) Calculate . 36. <br /> Depth of well : d purge. <br /> pDepth to water: 7 s Actual purge : 36, <br /> Depth to water: �f-12— <br /> Start purge: 35 _ Sampling time: 4 <br /> Time Temp. E. C. pH Turbidity Volume <br /> S 631 �- <br /> � H I s g 671 <br /> 9,h C 766 J. <br /> 70. 1 <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 />