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DOULOS ENVIRONMENTAu COMPANY Sr.�•1PLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon 0474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation:_ y w <br /> Stockton CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? 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" LM 12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other / t� C20 <br /> General condition of wellhead assembly: Excellent � Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:-Z,— Teflon bailer: <br /> Well Diameter: 2" 4" 619 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar e Measurement <br /> Time: = �- Time: = C Calculated pure: <br /> S� g <br /> (� <br /> Depth of well-: S Depth to water: /69 Actual purge:�- <br /> Depth to water: S Y •/ q <br /> Start purge: - 0/ Sampling time: <br /> Time Temp. E. C. pH- Turbidity Volume <br /> � 2Cf <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: i <br /> 4"" Locking cap: Lock'-Dolphin: - - 9/176 B61t: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> w wwww-i <br /> '.• Remarks: <br /> Signature: �` <br />