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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 Lane 1400 Well Designation 7 <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? jCMCP YES Above TOC Below TOC <br /> Is top of casing cut level? NO � If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(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 Fair Poor <br /> Purging Equipment 2" disposable bailer )C Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal primp <br /> Sampled with Disposable bailer)_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 1XI M" 6" 8" <br /> Purge Vol Multiplier 016 065 147 261 gal/ft <br /> Initial Measurement Recharge Measurement ' <br /> Time 7 = 4sS= I Time _ F : ,� � Calculated purge, <br /> . Depth of well S t!= �_� Depth to water yR' -4�f Actual purge <br /> Depth to water, 7 E2 <br /> Start purge , = 3c, Sampling time '3 <br /> Time Temperature EC pH Turbidity Volume <br /> Sample appearance- Lock <br /> Equipment replaced- (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7/32 AlIenhead <br /> 4"Locking Cap. Lock-Dolphin 9/16 Bolt- <br /> 6"Locking Cap: Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />