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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_L / <br /> • Site: Beacon #419 Pro3ect No. :- 94-419-01 <br /> 2350 Waterloo Road Well Designation:_ MW-5 <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? qN If no, see remarks <br /> Is well cap sealed and locked? NO ties if no, see remarks <br /> Height of well casing riser (in inches) �G <br /> Well cover type: 811 UV 121f UV�_ 1211 EMCO 811 BK <br /> 1211 BK 121' DWP 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2f1 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:X Teflon bailer: <br /> Well Diameter: 2f7 411 610 811 <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> lame:_- 1144 Time: -j-3 7 Calculated purge: <br /> epth of well: 6Y 5Z Depth to water: S �sl_ Actual purger_ <br /> Depth to water• 3 L_ OtS <br /> Start purge: 2 Sampling time: ),3V <br /> Time Temp. E. C. pH Turbidity Volume <br /> 70 ,t 11 3 <br /> V,- <br /> 1067 �� 3 <br /> Sample appearance: _ t �L _ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: / ! _ _ <br />