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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 Ly <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water m the well box? 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(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 _ Z2, 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" � 4" 6" 8 <br /> 22 <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time -7 - 20 Time /0::E0 Calculated purge 2 , -7 <br /> Depth of well S/ 50 Depth to water y8 d 3 Actual purge <br /> Depth to water- 731 <br /> - <br /> S tart purge /D-—�/ Sampling time /0.' y <br /> Time Temperature E C pH Turbidity Volume <br /> /� • 3d2 d'� •� a <br /> /o: 34/ / 7 •a� <br /> / 0 <br /> 0: y <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 Allenhead (DWP), <br /> Remarks ' <br /> � I <br /> Signature <br /> I <br />