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DOULOS ENVIRONMENTAL, INC, SAMPLING INF RMATION SHEET <br /> Client:_Ultramar„ _ Sampling Date <br /> Site. Beacon 3 41 Project No <br /> arnm : <br /> 1210 E.Har Lane Well Designation: <br /> Stockton Ca. <br /> Is setup of traffic control devices required? YES _ hours <br /> Is there standing water in the well box? YES Above TOC _�Below TOC <br /> we <br /> Is of casing cut level? NO If no, see remarks <br /> Is well cap scaled and locked? NO If no, see remarks <br /> Height or well casing riser(in inches): �/ Z <br /> Well cover type: 8"or 12" UV 12"EMCO 8"or 12"BK 8" Christy <br /> 12"Christy 8"M&D 12"M&D 12"D" <br /> ,­11TCVI 36"CNI 12"Pomeco Other: <br /> Goncrel condi on of wellhead ass.embly: Excellent Good ',�C�_ Fair. Poor <br /> i. <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer DOdicated bailer <br /> 4"PVC bailer . Contrifugai <br /> Sampled with: Disposable pump <br /> bailer Teflon bailer Disposable'�xbing_ � <br /> Well Diameter: 2" X, 4" 6" <br /> Bpi <br /> Purge Vol, Multiplier. 0.16, 0.65 I,4 <br /> Initial Measurement Rechar a Measure ent 2.61 gal/ft. <br /> . <br /> Time: _�j '. � 2 g�_ ,m <br /> Time:_ 1 - 2 Calculated purge: y <br /> Depth of well: 7 7" Depth to water: 70 1 Actu4l purge: 2 <br /> Depth to water: q . 6 $ <br /> Start purge: `. 5 Sampling time: <br /> Time Tem erature B.C. <br /> H TurbidiVolume <br /> lr=� 6 620 6 .71 <br /> LL <br /> 11 •'ti z .000, <br /> 3 ; <br /> Sample appearance: <br /> Lock; <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Lockn Cap! Lack-D-olphin: <br /> 9 jI6 Bolt- <br /> 6"Locking-Cap; Pinned AIlenhead (DVp); <br /> --_ <br /> Remarks: <br /> Signature: <br /> k <br />