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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: d' —/ 7 —� <br /> F{ f Site: Beacon #3641 Project No.: - <br /> 12 10 E.Hammer Lane1400 Well Designation: A l tU — <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? us Above TOC Below TOC <br /> Is top of casing cut level? NO 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"tMCO 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 GoodyZ_ 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 X, Teflon bailer Disposable Tubing <br /> Well Diameter: 2" 4" 6" V" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement 3' ' <br /> Time: = 3 3Time: = YJ Calculated purge: <br /> Depth of well: S` Depth to water: Actual purge: <br /> "'- Depth to water: a <br /> Start purge: f'L - Z Sampling time: /Z <br /> Time Temperature E.C. pH Turbidity Volume <br /> � 2 * 2� <br /> -23? <br /> - 7 ° � 7 • � <br /> 2 � S ?- 3S 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: j <br /> Signature: <br /> f <br />