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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> I Client: Ultramar Sampling Date: _2 -2- <br /> Site: <br /> 2Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Designation: M .� I <br /> Stockton Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? tQp 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 ?YEP If no,see remarks <br /> Height of well casing riser(in inches): 3 <br /> Well cover type: 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP 1I <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 <br /> "Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement -� <br /> Time: 8= Y q Time: -' / Calculated purge: <br /> Depth of well: 73 • / Depth to water: , C/ Actual purge: <br /> Depth to water: Y- 30 <br /> Start purge: - = f 4 <br /> Sampling time: <br /> Time Temperature E.C. H TurbidiLy Volume <br /> S <br /> 70 , 0 S30 <br /> 2 : 0 � <br /> 7 <br /> Sample appearance: __ /rte��— Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 AIlenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6"Locking Cap: Pinned AIIenhead (DWP): <br /> Remarks: <br /> Signature: <br />