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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 9 -). 1?-0 <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: _/-! Ids — 3 <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 el%D If no, see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches): 10 <br /> Well cover type: 8"or 12"W 12"EMCO 8"or 12"BK_>!�n_ 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"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"PVC 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 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ?:/ 3 Time: Calculated purge: 1 <br /> Depth of well: 7 Depth to water: ��• � Actual purge: / 3 <br /> Depth to water: __ S tll- 2 5' <br /> Start purge: = P—U Sampling time: - <br /> Time Tem erature E.C. pH Turbidity Volume <br /> 11: 21 70 ' a e <br /> 1122 70 ..x' 3c) !Y '7 . 5 Z <br /> 112 3 '7 2,- �5'2 7 <br /> 2 <br /> IV V- 6 0 7 .4` <br /> Sample appearance: Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin; 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br /> i <br />