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{ <br /> DOULOS ENVIRONMENTAL COMPANY SAMpj ING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_ <br /> Site: Beacon #474 Project No. : 94-474--01 <br /> 3440 E. Main Street Well Designation; Mj _1A <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked? No If no, see remarks <br /> Height of well casing riser (in inches) : 12l+ EMCO g+! BK <br /> Well cover type: 8 If UV_ 12!! TJV_ ^ Other <br /> 12" BK 1211 DWP 12++ CNI 36" CNI <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: ,..�..211 disposable bailer Submersible pump <br /> 21+ PVC bailer Dedicated bailer <br /> 4" PVC bailer _ Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> olI <br /> Well Diameter: 2+' 6 8 <br /> urge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> nitigl Measurement Rech---e Measu ement 6.7Calculated purge: <br /> Time: 15Z Time: , <br /> Depth of well: �"� 75 Depth to water: �� _ Actual purge: <br /> Depth to water: K <br /> Start purge:- /)- (- Sampling time: S) ._ <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: 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 Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />