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DOULOS ENVIRONMENTAL, INC, SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #3641 Project No;: <br /> 1210 E,Harnmer.Lane 1400 Well Designation: . Al 4,, <br /> Stockton.Ca. <br /> Is setup of traffic control devices required? AV YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing out level? NO If no, see remarks <br /> Is well cap scaled and locked? NO If no, see remarks <br /> Height of well casing riser(in inches): <br /> We]]cover type: 8" or 12"UV 12"$MCO 8"or 12"BK 8" Christy <br /> 12"Christy8" M&D�= 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Ponmeco Other; <br /> Gcngral condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dddicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with; Disposable bailer_�_ Teflon bailer Disposable Tubing__ <br /> Well Diameter: 2" 4" 6" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2,61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: : q Time: ._?$ Calculatod purge: 0 <br /> Depth of well: Depth to water: Actu4I purge: C) <br /> Depth to water _ __�# <br /> Start purge: r�= 5�_ Sampling time: 8 <br /> Time Temperature E.C. H Turbidit : Volume <br /> Z '3 70 7 <br /> . r <br /> 8 f-36 e7 <br /> a <br /> -* <br /> Sample appearance: Lock: Q � „ <br /> Equipment replaced: (check all that apply) Note condition of repIac'.ed items) <br /> 2"Locking Cap; Lock: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin; 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): , <br /> Remarks; <br /> Signature: <br /> i <br /> I <br /> I <br />