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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Desi <br /> Stockton.Ca. <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TQC <br /> Is top of casing out level? If no,see remarks <br /> Is well cap sealed and locked? �NO.. If no,see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"MIM 12"DWP . 1 <br /> 12"CM 36"CM I2"Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVA bailer Centrifugal pump <br /> Sampled with: Disposable bailer. Teflon bailer Disposable Tubing <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0,16 .65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: $ : Time: 2-,- 2 2 Calculated purge: <br /> Depth of well: 7` Depth to water: . Y q • °� 3 Actual purge: <br /> Depth to water: KI • ! <br /> Start purge: I_ �L �j Sampling time: 2 Z <br /> Time Temperature E.C. pH Turbidity Volume <br /> ! 2 f5�1 0 _ <br /> , I <br /> L 0 3 150 a 8ID Z <br /> ! ler <br /> -�cPY, *m <br /> ! = 2a <br /> 47, 7 6 - 6 ' <br /> scow <br /> 2 <br /> F�NlfRE <br /> Sample appearance: Com— Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 4/16 Bolt: <br /> 6" eking Cap: Pinned Allenhead (DWP): <br /> Remarks: $ 1–O ul p,- CC 1-1.4 p <br /> Signature: <br />