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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> r Client: Ultramar Sampling Date: <br /> Site: Beacon Project No. : 24-419 -01 <br /> 2350 <br /> -4 9- <br /> 2350 Waterloo Road Well Designation: MW- <br /> Stockton CA <br /> Is setup of traffic control devicesrequired? 1EP YES ES tiro e. hours <br /> TOC Below TOC <br /> Is there standing water in well box'. If no, see remarks <br /> Is top of casing cut level? NO � If no, see remarks <br /> Is well cap sealed and locked. V <br /> Height of well casing riser (in inches) : 12�� EMCO 8„ BK <br /> Well cover type: 8" UV+ 12 UV <br /> 12" BK� 12" DWP 12" CNH^ 36" CNI� Other <br /> General condition of wellhead assembly: Excellent <br /> 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: V <br /> Well Diameter: 2" <br /> 4"-4— 6n gn <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> ec ae easu ement Measurement Calculated purge: <br /> ime: Time: "- <br /> Depth of wellDepth to water: 4 <br /> : .�� Actual purge: <br /> Depth to water: H_ <br /> 12-D <br /> Start purge:, �-D 3 - Sampling time: <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> 17 37 �r <br /> 1511 7J.z <br /> Sample appearance: <br /> 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 Bolt. <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />. Remarks: <br /> signature: / Q�•rte°` <br />