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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: ?—.23-0 <br /> Site: Beacon#3641 Project No.: <br /> ;. <br /> 1210 E.Hammer Lane1400 Well Designation: _OL4 W <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 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 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other: --1 <br /> General condition of wellhead assembly: Excellent Good f' 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" g„ <br /> Purge.Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 7= Se Time: /0 -, 1 � Calculated purge: (9 ` 7 <br /> Depth of well: is 7. 20 Depth to water: S6_• �3 Actual purge: <br /> Depth to water:_ f y - <br /> Start purge: !D e Sampling time: O <br /> Time Temperature E.C. J pH Turbidity Volume <br /> !o =a G 7-09 <br /> z <br /> /0 -' 09 7/ . <br /> Sample appearance: Lock: <br /> - I <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 /> } <br /> 4 <br />