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DOUL0S ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:,, Ultramar Sampling Date: <br /> Site: Bgacon #412 Project No. : 94-419-91 <br /> 235Q Waterloo Road _ Well Designation: MW-a <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? a YES Above TOC Below TOC <br /> Is top of casing cut level? NO ITO If no, see remarks <br /> Is well ca sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : r-5 <br /> Well cover type: 8" UV,_„_,_ 1211 1211 E14CO 811 BK <br /> 12" BK 12" DWP_ 12" CNI 36" CNI they <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer 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" -41 4" 6" at$ <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2. 61 gal/ft. <br /> Tnitial uee eca aeauemet 133 <br /> Time; o Time: 4 Calculated purge: <br /> Depth of well; �6 33_ Depth to water: � � q Lo. Actual purge: 1� �+? <br /> Depth to water: ��3 <br /> Start purge: 1137 Sampling time:-LL uS_ <br /> Time Temp. E.C. pH Turbidity Volume <br /> J-1) q 6f, J- 761 2 <br /> 11-Lb 6, 5- 4 761 <br /> 0-41 1 6Y,6 <br /> Sample appearance: -,-. Lock., <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead:�� <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolts--� <br /> 6" Locking Cap: Pinned Allenhead (DWP) :--- _ <br /> Remarks: <br /> Signature: <br />