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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:- Ultramar Sampling Date: 11-21-�] 7 <br /> Site:. Beacon #419 Project No. : 94-419--01 <br /> 2350 Waterloo Road Well Designation: MW- <br /> Stockton, CA <br /> Is setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? No <M If no, see remarks <br /> Is well cap sealed and locked? NO `E If no, see remarks <br /> Height of well casing riser (in inches14 <br /> Well cover type: 8" UV 12" WY 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goo 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:-4— Teflon bailer: <br /> Well Diameter: 2" 411_�_ 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Rzme: /.� Time: 1-1 +-f Calculated purge: Z6, <br /> epth of well: 6770 Depth to water: C7, K y Actual purge: 2_6 6 .J <br /> Depth to water: S ,6; <br /> Start purge: Sampling time• 5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1014 702 1�_ L <br /> 2-oe 6 ,q0 7/0 3 <br /> 2-11 <br /> Sample appearance: C921-.. Lock: <br /> . — y <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 Ailenhead (DWP) : <br /> • Remarks: <br /> Signature: / <br />