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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> -DSI <br /> _ Client Ultramar Sampling Date 3 -,2z� ' <br /> • Site Beacon#3641 Protect No <br /> 1210 E Hammer Lane1400 Well Designation _f ' <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water in the well box? YES Above TOC Below TQC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? [ ND If no, see remarks <br /> Height of well casing riser(in inches) tJ <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 r't.� <br /> 12"CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good—X— 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"�K 4" 6" S" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time, 6 : 57 CY Time Y. Calculated purge 7 <br /> Depth of well 7 d/- Depth to water Actual purge <br /> Depth to water L - p <br /> Start purge = Sampling time a - <br /> Time Temperature E C pH Turbidity Volume <br /> =�� �4 • 2qo <br /> 7 - 36 y <br /> Sample appearance -- Lock p�,Ax <br /> —e� <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 />