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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Desi <br /> gnation: 14 IA,' <br /> Stockton Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? (2-MD 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): 45 <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 36"CNI 12"Pomeco Other: <br /> General condition of wellhead assembly: Excellent GoodoX, 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" /K 4" 657 g„ <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/f1. <br /> Initial Measurement Recharge Measurement <br /> Time: _ 7Time: = O Calculated purge: 7- g <br /> Depth of well: cS 7 r Depth to water: .5 7. Ogg Actual purge: _ <br /> Depth to water:_ S5. O <br /> Start purge: I *00 Sampling time: /� f <br /> Time Temperature E.C. H Turbidity Volume <br /> IL-o / 7D 2 305 - <br /> 1� � 0 70 - is' 2 30 <br /> 8 7 • Z 3 <br /> //: 0 7 �- el ! 7 0 7 . 2 <br /> Sample appearance: C lC_u Lock: / <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Loch: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-DoIphin: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />