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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 Lane 1400 Well Designation: /� r <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 lovely NQ If no, see remarks <br /> Is well cap scaled and locked? NO <SP 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"Chrisry8" M&D 12"M&D 12"DWP <br /> 12"CW 36" CNI 12"Porneco Other: <br /> General condition of wellhead assembly: Excellent Qood_>r Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer ><1 Cdntrifugal pump <br /> Sampled with: Disposable bailer L Teflon bailer Dispos4ble Tubing <br /> Well Diameter: 2" ><1 4" 6" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Q Time: 7 -' 3 0 Calculated purge: f ' �— <br /> Depth of well: Depth to water: }• Actu4I purge: <br /> Depth to water:_ S _ <br /> Startur e: <br /> R g _ _ � � � Sampling time: <br /> Time <br /> Temperature E.C. pH Turbidit ' Volume <br /> 7-50 <br /> 7 � 2 <br /> 1 = Z5r ,° y 7 - tom 3 <br /> 7 <br /> Sample appearance: Lock: f►,r! ,«�' <br /> Equipment replaced: (check all that apply) Note condition of repla , d 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 /> Rematks: <br /> Signature; <br />