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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: - 17 -d y <br /> r, Site: Beacon #3641 Project No.: - <br /> 12 10 E.Hammer Lane 1400 Well Designation: VW <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top.of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? IO NO E If no, see remarks <br /> Height of well casing riser(in inches): ! <br /> Well cover type: 8"or 12"UY 12"EMCO 8"or 12"13K 8" Christy <br /> I2"Christy8"M&D 12"M&D 12"DWP <br /> ,n"--CM 36"CM 12"Pomeco Other: <br /> General condi 'on of wellhead assembly: Excellent Qood 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 �2�- Teflon bailer Disposable Tubing <br /> Well Diameter: 2" L 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Z = Time: = Calculated purge: <br /> Depth of well: Depth to water: , Actual purge: • <br /> Depth to water: S 7 - 2 <br /> Start purge: Sampling time: <br /> Time Temperature E.C. H Turbidity Volume <br /> 650 -7 <br /> j- 13 <br /> I . <br /> Sample appearance: 6A Lock: <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lack: 7132 Allenhead: <br /> 4"Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />