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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 VW <br /> Stockton.Ca <br /> Is setup of traffic control devices required? C!ND YES time hours <br /> Is there standing water in the well box? (!2:> YES Above TOC Below TOC <br /> Is top of casing cut Ievel? 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"DW? <br /> —32"CNI I W 36" CNI 12" Porneco Other <br /> General condi on 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_ 2!�, Teflon bailer Disposable Tubing <br /> Well Diameter 2" _2!!�. 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time _ -7-�K2 Time /012 3 Calculated purge D <br /> • Depth of well c? - 6 �7 Depth to water y 7- Actual purge O - 8 <br /> Depth to water Y7- 3X <br /> Start purge / '/3 Sampling time /0 =2 <br /> Time Tem erature E C pH Turbidity Volume <br /> /o3 6 0 —7 - <br /> C:) <br /> 0 1 • 2. �l 2 <br /> /� = 70 • 2 <br /> r 0 <br /> Sam learr appearance C.— C 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 (DWT). <br /> Remarks <br /> 4 <br /> Signature <br />