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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 9 —0 <br /> Site: Beacon#3641 Project No.: <br /> 1':•, 1210 E.Hammer Lane 1400 Well Designation: 14W -- <br /> . <br /> Stockton.Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI__X_ 36"GNI 12"Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good-,C,, 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 Teflon bailer Disposable Tubing ,,� <br /> Well Diameter: 2" 4" 6" $" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/fl. <br /> Initial Measurement Recharge Measurement_ <br /> Time: 7 Time: - 10 ' 3 / Calculated purge: - <br /> Depth of well: 7/• 5 Depth to water: -1546 . /3 Actual purge: 1 <br /> Depth to water: 3• <br /> Start purge: /0 2-O Sampling time: <br /> Time Temperature E.C. J pH Turbidi y rVjolume <br /> 021 70 • � �� 'K , C/o <br /> 0 = 22 7a - 2 y � � •gs <br /> lo ; 70 . �� 6 • 80 3 <br /> /o <br /> Sample appearance: 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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />