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= DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> • Site Beacon #3641 Project No / <br /> 1210 E Hammer Lane1400 Well Designation K, � O <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 TOC <br /> Is top of castng cut level? NO If no, see remarks <br /> Is well cap sealed and locked? 7 NO If no,see remarks <br /> Height of well casing riser(in inches) J <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"CM 36"CNI 12" Pomeco Other <br /> General condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2"�_ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ; 5 Time _ e �/ Calculated purge 7 <br /> Depth of well S - 6 Depth to water Actual purge <br /> Depth to water -t/4( , o <br /> Start purge t =D Sampling time <br /> Time_ Temperature E C H TurbidityVolume <br /> 9- 0 -768 . 3 �� 7.y/ <br /> _d �o • / 3 27 3 Z- <br /> R <br /> R `7a • `�. rl� 7.20 3 <br /> ���v o • � c�5 7 !� <br /> Sample appearance Lock �4'L' <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 />