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j DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> a Client Ultramar Sampling Date <br /> • Site Beacon #3641 Project No qq <br /> 1210 E Hammer Lane1400 Well Designation W r Stockton,Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water m the well box? YES Above TOC Below TOC <br /> Is top of casing cut levels O dD If no, see remarks <br /> is well cap sealed and locked? NO r17S—'D If no, see remarks <br /> Height of well casing riser(m inches) <br /> Well cover type 8"or 12"UV 12" EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty 8"M&D 12" M&D 12"DWP <br /> 12" CNI�� 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good__,2S,. 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 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 6 : Time ey. 0 A Calculated purge <br /> Depth of well 7/• Q Depth to water -//97a Actual purge <br /> Depth to water <br /> Start purge 7., 5- S Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> 7 - 6 er -7 3o3l 7 0 <br /> = S 7 <br /> 21/ 070 - v <br /> -7 ,'Ly <br /> 7 3 <br /> X10 7. 2 � 3 <br /> Sample appearanceLock J <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 Boit <br /> 6"Locking Cap- Pinned Allenhead (DWP) <br /> . Remarks <br /> Signature <br />