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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_ <br /> Site: Beacon _#_Lift- _ Pro3ect No. : 94-4/1 -01 <br /> X350 W�_" a Well Designation: MW- <br /> CA. <br /> Is setup of traffic control devices required? 19YES tim hours <br /> Is there standing water in well box? ve T Below TOC <br /> Is top of casing cut level's NO If no, see remarks <br /> Is well cap sealed and locked? NOvtM If no, see remarks <br /> Height of well casing riser (in inches) : <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 <br /> ..l � Poo _ <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal 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: 13-7 -- Time: '-W Calculated purge: <br /> Depth of well: - Depth to water: 69.14 Actual purge: 54.i 9 <br /> Depth to water: C4�_+ <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Zo <br /> 74 <br /> Sample appearance: 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 /> Remarks: <br /> Signature: 1 � �` <br />