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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: B —2 Q—O <br /> Site: Beacon#3641 Project No.: <br /> ,Fsr< 1210 E.Hammer Lane1400 Well Designation: /LI <br /> Stockton Ca. <br /> Is setup of traffic control devices required? 12D 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 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"Christy8"M&D 12"M&D I2"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: X -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" X _ 4" 612 g)) <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: = O Time: - /0 k� -15—"o Calculated purge: r*• 3 <br /> Depth of well: f - 7 Depth to water: 5- 3 - 10 Actual purge: J . <br /> Depth to water:_ S 2q 2— <br /> Start <br /> Start purge: Sampling time: /0 <br /> Time Temperature E.C. pH Turb—idit <br /> y Volume <br /> 0 76 - 2 ( 3p _ DY <br /> -/0-1 / 70 - o 61"•! z <br /> /o = y 7l• / S y S i ' - <br /> 3 <br /> y/ . S y o <br /> Sample appearance: y 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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />