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DOVLOS ENVIRONMENTAL COMPANY SJUIxJNG INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 9`�'y�,_._ <br /> Project No. : 94-474-01 <br /> Site: feacon474 <br /> 3440 E. Main Street Well Designation: MW- <br /> Stockton 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 <br /> sealed and locked? NO WE If no, see remarks <br /> Height of well casing riser (in inches) : <br /> �� <br /> Well cover type: 8" UV 1 n 12 EMCO 8" BK_2 iTV ether l: <br /> 12" BK 12" DWP 12" CNI, 36" CNI� <br /> General condition of wellhead assembly: Excellent oo- Fair Poor <br /> Submersible pump <br /> Purging Equipment: 2" disposable bailer Dedicated bailer <br /> 2" PVC bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: _. Teflon bailer: <br /> S n <br /> Well Diameter: 2" 4"_ 6 <br /> AmPurge V01. Multiplier: 0. 16 O. 65 1. 47 2. 61 gal/ft. <br /> r,ltia Measurement Recharge Measurement <br /> Time: l Time:/LII_ Calculated purge: //. S <br /> Depth of well Depth to water: Actual purge: I! '1 - <br /> Depth to water: a"�1./J _ <br /> Start purge: / L 1 sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> � �.. 5 <br /> 73 , 14fri <br /> �-16 71: <br /> Sample appearance: CAA e_, Lock: <br /> Equipment replaced• (Check all that apply) Note condition of replace em <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 />