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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon#419 Probed No 94-419-01 <br /> 2350 Waterloo Well Designation MW_ <br /> Stockton.C <br /> Is setup of traffic control devices required? O YES time hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO 10 If no,see remarks <br /> Is well cap sealed and locked? NO If no,we remarks <br /> Height of well casing riser(in inches) U <br /> Well cover type 8"UV l2"UV 12"EMCO8"BK <br /> 12"BK 12" DPW 12"CNI 36" CNI Other <br /> General condition of wellhead assembly Excellent Farr Poor <br /> Purging Equipment: 2"disposable bailer Submersible pump <br /> 3" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centr3fiigal pump <br /> Sampled with Disposable bailer Teflon baler <br /> Well diameter 2" 4" 6" 8" <br /> Purge Vol. Mulhpba 016 065 147 261 gaUR <br /> Initial Measiuement Mechmge Mcom me_n_t <br /> . Tune Toners u Calculated purge S 4 <br /> Depth of well Depth to water ' Actual purge 54. / it <br /> Depth to water 6 a <br /> Stan purge Sampling time /Q 1S <br /> Tine Temperature E C pH Turbidity Volume <br /> Sample appearance r. • ].oak <br /> Equipment replaced (Chock all that apply) Note condition of replaced items <br /> 2"locking cap Lock#3753 7/32 Allenhead <br /> 4"locking cap Lock-Dolphin 9116 bolt <br /> 6"locking cap Pinned Allenhead(DPW) <br /> Remarks <br /> Signature <br />