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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: ' <br /> • <br /> Site: Beacon #419 Project No. : 94-41.9-01 <br /> 2350 Waterloo Road Well Designation: MW_ a_ <br /> Stockton, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YE Above TOC Below TOC <br /> Is top of casing cut level? O E if no, sere remarks <br /> Is well cap sealed and locked> NO S If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" EMCO_ 2�-, - 8" BK <br /> 12" BK 12" DWP 12" CNT 36" CNI Other <br /> General condition of wellhead assembly: Excellent �o 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: 21' 4" ` X 6" 8=1 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement � <br /> Time: I =5 _ rI Time: f� U Calculated purge: <br /> Depth of well.: D,Depth to water: l y �� Actual purge: /6 9 <br /> Depth to water• �-I 2 <br /> L <br /> Start purge: h Sampling time: �' - <br /> Time Temp. E.C. pH Turbidity Volume <br /> 67 } r ' ' <br /> t f n - <br /> sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note conditiorY�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 /> J <br /> Signature: �'- / <br />