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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 <br /> Stockton,Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level? NO 4J�gtP If no, see remarks <br /> Is well cap sealed and locked? NO dMD If no, see remarks <br /> Height of well casing riser(in inches) r V <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8" Christy- <br /> 12" <br /> hrisry12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CM 36" CNI Y_ 12"Potneco Other <br /> General condition of wellhead assembly Excellent Good Pair 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" X, 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ] � 2 S_ Time 1:5 7 Calculated purge <br /> Depth of well, --- <br /> 4< 5'• 0.2 Depth to water Actual purge f <br /> Depth to water __ 7 -?-o_ <br /> Start purge q: Sampling time q = Sem <br /> Time Temperature E C 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 Allenhead _ <br /> 4"Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6"Locking Cap Pinned AIlenhead (DWP), <br /> Remarks ' <br /> Signature <br />