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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No <br /> 5 <br /> 1210 E Hammer Lane 1400 Well Designation ✓W - 7 <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES tune Hours <br /> Is there standing water m the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? S em If no, see remarks <br /> Is well cap sealed and locked? ,O NO If no, see remarks <br /> Height of well casing riser(in 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 /> WP-CNI36"CNI 12"Pomeco 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 _ Teflon bailer Disposable Tubing_ <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time- 7:y6 Time f Q 2 Calculated purge- eIr- <br /> Depth of well Depth to water y e leg Actual purge f - O __ <br /> . Depth to water <br /> Start purge /0 : a y Sampling time = <br /> Time Temperature EC 2H / Turbidity Volume <br /> o: o� <br /> 0101, <br /> Sample appearanceLock <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 /> • <br /> s <br /> Signature <br />