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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> le Client: Ultramar Sampling Date: 6/'— <br /> F <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? O If no, see remarks <br /> Is well cap sealed and locked? N1 If no, see remarks <br /> Height of well casing riser (in inches) _ <br /> Well cover type: 8" UV 12" UV , C 12" EMCO <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent 2—M Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer 7d 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 /> In tial Measurement Recharge Measurement <br /> Time: = D Time: = l Calculated purge: <br /> Depth ot well: l Depth to water: Actual purge: <br /> Depth to water: <br /> - ASI <br /> Start Purge:� Sampling time: __ S <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearance: '���� Lock: <br /> Equipment replaced: (Check all that apply) Note condition f replaced item <br /> 12" 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 />