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i <br /> DOULOS ENVIRONMENTAL COMPANY S,iLMPLING INFORMATION SHEET <br /> • Client: Ultramar Sampling Date: _ ..� - ( C <br /> `0 <br /> - - <br /> Site: Beacon #474 Project No. : 94-474--01 <br /> 3440E. Main Street Well Designation: MW- J <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? 40OrmIf 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" UV 12" UV ~12" EMCO 8" BKO <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" 611 8" <br /> Purge Vol. Multiplier: 0.16 0. 65 1. 47 2 . 61 gal/ft. <br /> 'tial Measurement Recharge- Measurement <br /> Time: Time: l : -3 )? Calculated purge: 13 - <br /> Depth of well : ��" y� Depth to water:. '� Actual purge <br /> Depth to water: <br /> Start purge: �p 3C7 Sampling time:��� r `� <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7• //' / 3 `7 ��� - <br /> Sample appearance: 2 :c/`' 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 -Pap:- v Lock-Dolphin:- - 9/16 -Bolt: k <br /> 6" Locking Cap: Punned Allenhead (DWP) : <br /> i� Remarks: <br /> Signature: � .� <br />