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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 0 <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane1400 Well Designation MW r <br /> Stockton Ca <br /> Is setup of traffic control devices required9 65) YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? TIf no, see remarks <br /> Is well cap sealed and locked? NO ES If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 12" EMCO 8"or 12"BK 8" Christy <br /> 12"Christy 8"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 X, 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 0.65 147 2,61 gal/ft <br /> Initial Measurement Recharge Measurement_ <br /> Time `7-'IV Time. q' -�2 y __ Calculated purge 141 <br /> Depth of well 7 3 • +� Depth to water Actual purge <br /> Depth to water* _�{ 7• <br /> Start purge % D Sampling time °c <br /> Time Temperature I EC pH Turbidity Volume <br /> 9' 0 7 3 06 -7+ <br /> r :IG 69 , `7 f- 7. 3 <br /> 60 <br /> V <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"Lacking Cap Pinned Allenhead (DWP). <br /> Remarks <br /> 4 <br /> Signature <br />