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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> NNW <br /> Client Ultramar Sampling Date 5 . �4y <br /> • Site Beacon #3641 Project No . - <br /> 1210 E Hammer Lane1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water in the well box9 YES Above TOC Below TQC <br /> Is top of casing cut level? NO (yvmIf 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"CM 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer._ k Teflon bailer Disposable Tubing__ <br /> Well Diameter 2"_ 4" 6" g" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> hutial Measurement Recharge Measurement <br /> Time _ 2 :30 Time / =aQ Calculated purge _ s <br /> • Depth of well 55 y- e<? Depth to water Q Actual purge � <br /> Depth to water 7. 7 ep y <br /> Start purge /0 _k y Sampling time 11re <br /> Time Temperature EC pH Turbidit Volume <br /> /o=scS '7// - Z � 7 <br /> U 3 <br /> /a <br /> -7 ,/ r J7 ZG o 7 /G <br /> Sample appearance Lock <br /> JW <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 /> s <br /> Signature <br />