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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Y n <br /> Client: Ultramar Sampling Date:1I-J-/�_ <br /> • Site: Beacon_ #419 _ Project No. :- -94-419-01 <br /> 2350 Waterloo Road Well Designation: MW- 3 <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap `sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" UV 12" UV 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 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" 4" 611 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Aftitial Measurement Rechar a Measurement J <br /> me: S Time:_. Y0 Calculated purge: e 7- 5 o✓1 <br /> Depth of well: c�' - Depth to water: S 9 /a Actual purge: 62 S Sw/ <br /> Depth to water: <br /> Start purge: 3 7 Sampling time: 3 y� <br /> Time Temp. E.C. pH Turbidity Volume <br /> 9 69 S 13 0 <br /> 133 0 3 <br /> 67 290 7 r1 y <br /> Sample appearance: cez=f=:a2r Lock: <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 /> &-emarks: <br /> Signature: <br />