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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date ' -CJ <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lanel400 Well Designation ltI tv <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? NO If no, see remarks <br /> Is well cap sealed and locked? 0 NO If no, see remarks <br /> Height of well casing user(iii 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 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 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 7 = le Time 9. n Calculated purge 2,e!5 • —7 <br /> . Depth of well 717. 7Depth to water Yi?• /0 Actual purge T 2 ev <br /> Depth to water _ G/7. 1//-- <br /> Start <br /> 1/_Start purge Sampling time 9 • t-leg. <br /> Time Tem erature EC 2H Turbidity Volume <br /> T3 1 ' Q � • � <br /> q : 33 70 7 <br /> : 5' p • 3 2l 7 �5 <br /> 3 <br /> = 4C ]� 170q 7 yip <br /> Sample appearance Lock <br /> Equipment replaced- (check all that apply) Note condition of replaced itern(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 <br /> 1 <br /> Signature <br />