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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 Designation: <br /> Stockton Ca. <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing water in the well box? NO YES Above TOC Below TOC <br /> Is top of casing cut level? NO YES If no,see remarks <br /> Is well cap sealed and Iocked? NO YES If no,see remarks <br /> Height of well casing riser(in inches): <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 Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"FVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer_ C= Teflon bailer Disposable Tubing^` <br /> Well Diameter: 2" '0. <br /> }�. 4" 6" g» <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: F.- y/ Time: - 4 Calculated purge: 6 - 6 <br /> Depth of well: 4�'V. 6 Z Depth to water: _ S f a Actual purge: - <br /> Depth to water:_ 5'1• l f <br /> J Start purge: O �6 Sampling time: 3-- 0 <br /> Time Temperature E.C. pH Turbidity Volume <br /> . O ? 7O $ sad r / Q <br /> Sample appearance: _ rig–•r— Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />