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DOULOS ENVIRONMENTAL, INC, SAMPLING INFORMATION SHEET <br /> Client: Ultramar_ _ Sampling Date- <br /> Site: Beacon #3641 Project No : <br /> ' 1210 B.H!! er Larie1400 . f <br /> . Well Designation: 11 W <br /> Stockton,Ca. <br /> Is setup of traffic control devices required?' YES time: ;hours <br /> Is there standing water in the well box? D YES Above TQC Below TOC <br /> Is top of casing cut level? NO effl <br /> 5> If no, see remarks <br /> Is well cap sealed and locked? f NO 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 g"Chrl$:ty— <br /> ITIPhristy 8"M&D 12"M&D 12"DWF <br /> 'CNI�— 36" CNI 12"Pomeco Other; <br /> Ompral condipon of wellhead asscrnbly: Excellent <br /> Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Selbmersible pump <br /> 2"PVC bailer DOdica-ted bailer- <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer <br /> --- — Dispos4ble Tubing <br /> Well Diameter: 2"`� 4" 6" g;, <br /> Purge Vol. Multiplier: 0.16. 0,65 1.4 <br /> 2.61 gal/ft,Initial Measurement <br /> Bechar a Measurement <br /> Time: , Time: 2 ' 30 CalculatOd purge: 7 <br /> Depth ofwell:~`• Ss• � Z- Depth to water: 9 6 <br /> • 64:9 Ac 3 <br /> Depth to water: h141 purge; .3. -7 <br /> Start purge: 2 R Sampling time: 1 = 3 <br /> Time Tem erature E.C. PH , Turbidi.. Volume <br /> ] 2. . �' v <br /> 1 � F� � <br /> r <br /> Sample appearance: Lock: � <br /> Equipment replaced: (check all that apply) Note condition of repfacled items) r <br /> 2"Locking Cap. ' Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin 916 Bolt: <br /> 6"Locking Cap, Pinned Allenhead (D"); <br /> Remarks: <br /> Signature: <br />