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DOULOS ENVIRONMENTAL, INC, SAMPLING INFORMATION SHEET <br /> Client:--Ultramar Sampling Date: -lac r <br /> Site: Beacon #3641 Project NO,: <br /> 1210 E.Hammer Lane 1400 Well Designation: <br /> Stockton•Ca, <br /> Is setup of traffic control deices 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 <M If no, see remarks <br /> Is well cap scaled and locked? NO E If no, see remarks <br /> Height of welt casing riser(in inches): <br /> Well cover type: 8" or 12"UV_��L 12" EMCO 8"or 12"BK 8" Christy <br /> 12"Christy 8"M&D 12"M&D 12"DYWP <br /> 12"CM 36"CNI 12"Porno Other: <br /> Gcnval condition of wellhead assembly: Excellent Good___ Taira Poor <br /> Purging Equipment: 2" disposable bailer S-0mersible pump <br /> 2"PVC bailer D6dicated bailer <br /> 4"PVC bailerr' 4 <br /> Ce ntrifuga! pump <br /> Sampled with: Disposable bailerr__. Teflon bailer Disposable Tubing <br /> Well Diarrleter: 2" 4" 61P_ $r+ <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.6I gallfl• <br /> Initial Measurement Recharge Measurement <br /> Time: 6 ; Time: 1 =Za Calculatgd purge; l •8 <br /> Depth of well: 5 Depth to water: j'2 Actu4l purge: <br /> Depth to water; <br /> Start purge: 7. 1/0 Sampling time: 7- <br /> Time Temperature E.C. pH Turbidi Volume <br /> s <br /> 7 / <br /> 7=112 4-3 / 2 �r 7 • � <br /> 7 ',&3 7 - <br /> Sample appearance: Lock; Pta <br /> Equipment replaced; (check all that apply) Note condition of repfaced item(s) <br /> 2"Locking Cap: ' Lock: 7/32 Allenhead: <br /> 4"Locking Cap., Lock-Dolphin: <br /> 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: ' <br /> Signature: <br />