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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: UItramar Sampling Date: d ' 7r <br /> Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: M w — <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? 107) 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"CNI 12"Pomeco Other: <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer L 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: _ /= y� Time: 2 = 1 Calculated purge: 3 ' 2- <br /> Depth <br /> Depth of well: - be 4 Depth to water: ,�'- g Actual purge: <br /> j Depth to water: <br /> Start purge: _ 1_�=_�� Sampling time: Z S <br /> Time Temperature E.C. pH Turbidity Volume <br /> =0 3 B�� o S• o Z <br /> 2 :a `f t�3 � 1023 86s ' <br /> 3 <br /> g.oy <br /> Sample appearance: Lock: <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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP); <br /> Remarks: <br /> 4 <br /> Signature: <br />