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Y n <br /> DOULOS ENVIRONMENTA; `OMPANY SA"'JUNG INFORMATION SHEET <br /> Client: Ultramar- Sampling Date: `. <br /> 10 Site: Beacon #474„ _ Project No. : _94-474-01. <br /> _ 34.40 E. Main Street Well Designation: Mw- <br /> StOChton, 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" UV 12" UV . 12" EMCO_ 8" BK <br /> 12+' BK 12" DWP 12" CNI 36" CNI Other _1;r <br /> General condition of wellhead assembly: Excellent od Fair Poor <br /> Purging Equipment: 2" disposable bailer -X submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: P Teflon bailer: <br /> Well Diameter: 2" 4n_____ 6"- 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/€t. <br /> ,jnitAal Beasuremerzt e`h ar He sure e <br /> Time: � ;_Su Time: Calculated purge. l 3 <br /> Depth of well— 7 � Depth to water: - /0 Actual purge:y� . <br /> Depth to water:--S-6 <br /> Start purge: Sampling time:_ - C <br /> Time Temp. E.C. pH Turbidity Volume <br /> . V -7 .� f <br /> 7 =S-z/ G . a 1260 -7 •F "I 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: " (Check all that-apply):- Note condition of replaced item <br /> 2" Locking Cap: Lock 03753; 7/32 Allenhead:�,�=-= <br /> 4" Locking Cap; Lock-Dolphin: 9/16 Bolt: - <br /> 6" Locking Cap: Pinned Allenhead OWN : <br /> Remarks: <br /> Signature: <br />