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DOULOS ENVIRONMENTAL OKPANY SA LING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:, <br /> Site: Beacon #474 Project No. : 94-474-01 i <br /> 3440 E. Main Street Well Designation: <br /> Stockton CA <br /> Is setup of traffic control devices required? C� YES time:_ hours <br /> Is there standing water in well box? CTCD YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well ca sealed and locked? NO If See ee remarks <br /> Height of well casing riser (in che1211 UVs 1211 EMCO 8++r BKS <br /> Well cover type: 8 UV ++ 36" CNI �O r I- A00 " � <br /> 12" BK_ 1211 DWP� 12 CNIExcellent o Fair Poor <br /> General condition of wellhead assembly: <br /> Purging Equipment: 21+ disposable bailer Submersible pump <br /> 2++ PVC bailer Dedicated bailer <br /> ^� <br /> 4++ PVC bailer > Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2"� 4ff 6++ 8" <br /> Purge Vol. Multiplier: 0. 16 echarae6Measu el.47 ent " 2.51 gal/ft. <br /> Initial Measurement Calculated purge: <br /> 7 = /�1 Time: ' ! : O <br /> Time: -GT T. / 3 Depth to water: S'f'• (05' Actual purge <br /> Depth of well: <br /> Depth to water: S -© <br /> Start purge:_ I/=O 3 sampling ling time: <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> 1/ :0 c/ C 7. '? / 9q ( 7 r /D <br /> o 9v <br /> Sample appearance: r Lack: <br /> D <br /> z ment replaced: (Che ' <br /> ck all that apply} Note condition of replaced item <br /> Eg2f'pLockingpCap: Lock #3753 :_ � 7/32 9/16AlleBolt: <br /> ff Lock-Dolphin:- 9/16 Bolt: <br /> 4 Locking Cap. <br /> 6" Locking Cap: pinned Allenhead (DWP) . <br /> Remarks: <br /> Signature: <br />