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DOULOS ENVIRONMENTAL, COMPANY S.,,riPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Dater 3 _ `7 <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' 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 If no, see remarks <br /> Height of well casing riser (in -inches) : <br /> Well cover type: 8" UV12" 67__Z 12" CO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI other <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: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0 .16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement R-e-charge Measurement <br /> Time: 2 * a � ' Time: /O - Z? Calculated purge: 57 <br /> Depth of well : Depth to water: 6 ' Actual purge: <br /> Depth to water: _�i2 f� <br /> Start purge: S Sampling time: /� • 2 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7D 7 - <br /> !0 �� yo �y <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition o/replaced item <br /> 2" Locking Cap: Lock #3753 : 7/ 32 Allenhead: <br /> 41 -�Locking .Cap Lock-Dolphin': 9/16 'Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : ' <br /> Remarks: <br /> -Signature.- <br />