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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: G= / —7— ©�f <br /> Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Designation: w r <br /> Stockton Ca. <br /> Is setup of traffic control devices required? Ap 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 <br /> M If no, see remarks <br /> Is well cap sealed and locked? 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 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CM 12" Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good ,X Fair Poor <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 Disposable Tubing <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: j 1 = 3 4 Time: 16 . Calculated purge: 3 <br /> =, Depth of well: Depth to water: < Actual purge: • Q <br /> Depth to water: <br /> Startur e: <br /> p g j 0 5` Sampling time: <br /> Time Tem erature E.C. pH Turbidity Volume <br /> od -7 S 'U 8 SAE)S <br /> 0 9 -oG <br /> Sample appearance: Lock: _ ey <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9116 Bolt: <br /> 6"hocking Cap: Pinned Allonhead (DWI): <br /> Remarks: <br /> 4 <br /> Signature: <br /> i <br />