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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3-21`9 <br /> Site: Beacon 419 Project No. : 4- - 1 <br /> 2354 Waterloo Road Well Designation: MW- <br /> Stockton. CA <br /> Is setup of traffic control devices required? N YAs time: hours <br /> Is there standing water in well box? SES Above TOC Below TOC <br /> Is top of casing cut level? Va If no, see remarks <br /> Is well cap sealed and locked? NO XEE9 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" IP 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 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 bailerCentrifugal pump <br /> Sampled with: Disposable bailer:_ .,y � Teflon bailer: <br /> Well Diameter: 2" ' 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 103 b Time: J./LCalculated purge:-L) <br /> Depth of well: ff���-� Depth to water: b-l- a Actual purge: .A 7 <br /> Depth to water: 0C.--4 <br /> Start purge: �1 Sampling time: �L <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3fif <br /> < 1 Lr ' 7� / <br /> LL03 7z--5 3 <br /> Sample appearance: Lock: rpt <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Balt:_ <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />. Remarks: <br /> Signature: <br />