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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon 1419 Project No. : 94,_419-01 <br /> 2350 Waterloo Road Well Designation: MW- <br /> Stockton CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? <V YES Above TOC Below TOC <br /> Is top of casing cut level? NO Y If no, see remarks <br /> Is well cap sealed and locked? NO VRS If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV a' 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI --Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailerSubmersible 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 /> Initial Measurement Recharge Measurement <br />. Time: II)41 Time: 11q Calculated purge: <br /> Depth of well: C! / Depth to water:_ 9 Actual purge: 94.4 <br /> Depth to water: W-.4? <br /> Start purge: /Z- sampling time: /LD <br /> Time Temp. E.C. pH Turbidity Volume <br /> /155 <br /> / 0 / <br /> 116 <br /> Sample appearance: -., Lock: 2 �e,- <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 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> iRemarks: <br /> Signature: <br />