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DOULOS ENVIRONMENTAL .;OMPANY S1 'LING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:-3z Z <br /> iSite: Beacon g474 Project No. : 94-474-01 <br /> 3440 E. Main Street Well Designation: MW- y <br /> Stockton CA <br /> Is setup of traffic control devices required? (:J§� YES time: hours <br /> Is there standing water in well box? CM 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) : 12" EMCO 811 <br /> Well cover type: 8" UV— 12" W 1 <br /> �� 3 6" CNI - Other � �K <br /> 12" BK 12+' DWP 12 CNI� Excellent t Fair Poor <br /> General condition of wellhead assembly: <br /> Purging Equipment: 2" disposable bailer /14*-, Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> ^�4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer Teflon bailer:__ <br /> Well Diameter: 211 4�'� 6" $" <br /> Purge Vol. Multiplier: . 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement echa e Measurement fg <br /> . Time: Time: �` '• -S Calculated purge: <br /> Depth of well: Depth to water: .5 .°r Actual purge: <br /> Depth to water: <br /> Start purge: <br /> —L-2J6-7: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> VO <br /> 3 °� 6 3 � � 210 ? • 3 c7 ��' � <br /> IL2: 3 « � •� � � �-� <br /> Sample appearance: Lock: 1 <br /> - = Note condition _ <br /> Equipment replaced- : (Check'a11 'that apply) - 7/32 Allenhead: <br /> dition of replaced .ite <br /> 2" Locking Cap: _ Lock #3753 . <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: ,_ Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />