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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Dat6: <br /> Site: Beacon #t'3641 Project No,: <br /> 1210 E.Hammer Lane 1400 WeI1 Designation: 1/k, <br /> —� <br /> Stockton–Ca, <br /> Is setup of traffic control devices required? e1jo YES tune: 'hours <br /> Is there standing water in the well box? Y Above TQC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap scaled and locked? d/ NO If no, see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"UV 12"$MCO 8" or 12"BK 8" Christy <br /> 12"Christy 8" M&D 12"M&D 12"DW? <br /> 12"CNI 36" CNI 12"Pomeco Other: <br /> Gcnpral condition of wellhead assembly: Excellent Good Fair Foor <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 Teflon bailer Disposbie Tubing <br /> Well Diameter: 2"���` 4" 6"_ 811 <br /> Purge Vol, Multiplier: 0,16 0.65 1.47 2.61 gal/ft, <br /> Initial Measurement Recharge Measurement <br /> Time: 7 ' ATime: R9 Calculatod purge: <br /> Depth of well; Depth to water: Actual purge: <br /> Depth to water: �. <br /> Start purge: $ _ Sampling time: r �� <br /> Time Temperature E.C. pH Turbidi Volume <br /> I <br /> Sample appearance: Lock; -?' A-- <br /> Equipment replaced: (check all that apply) Note condition ofreplaced item(s) r <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9x16 Bolt: � <br /> 6"Locking Cap: Pinned AIlenhead (DWP): <br /> Remarks: <br /> Signature: <br />