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DOQLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beapon 1419 Project No. : -4 <br /> —2350 Waterloo Road 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? 1Q XU Above TOC Below TOC <br /> Is top of casing cut level? NO W If no, see remarks <br /> Is well cap sealed and locked? No T40 If no, see remarks <br /> Height of well casing riser (in inches) : 36" CNI12" „ BK— <br /> Well cover type: 8" UV12 � EMCO g,�,_ O other <br /> " W <br /> 12" BK 12" DWP 12" CNI_�. Excellent o Fair Poor <br /> General condition of wellhead assembly: <br /> Purging Equipment: 2" disposable bailer N Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: - - <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> Tnitisl Mea urementechar e Me su eme t /� 7aw_( <br /> 4rime: /05A Time: Calculated purge:_____� <br /> Depth of well• 41-- Depth to water: 49Ct Actual purge. <br /> Depth to water: 7 <br /> Start purge: o7 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1 � �- //tri �K <br /> ; is 5�, 7 7J 7J ?' <br /> Sample appearance: Lock: _ <br /> P 1 PP ' � - - <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 (DWP) :�_ <br /> is Remarks: <br /> Signature: � <br />