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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: -3- 3 - 05 <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Harnmer Lane1400 Well Designation: <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 /792 If no, see remarks <br /> Is well cap sealed and locked? �/ NO S 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"CM �C 36"CNI 12"Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good! r 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 y-, Teflon bailer Disposable Tubing <br /> Well Diameter: 2" 0" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:- T113--_ Time: ,/O : / 6 Calculated purge: 1 L/ - <br /> Depth of well: 7/- 3 Depth to water: S c r Actual purge: / y <br /> Depth to water: CY 3 '' <br /> Start purge; /0 "/0 Sampling time: 10 " 17 <br /> Time Temperature E.C. pH TurtjqLty Volume <br /> T l O - <br /> 7 , 01 <br /> 7 .0 <br /> Sample appearance: f 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 BoIt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> 4 <br /> Signature: <br />