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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date ,� C3 <br /> r � <br /> . Site Beacon#3641 - Project No <br /> 1210 E Hammer Lane 1400 Well Designation ' <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy 69 NMQ Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO S If no, see remarks <br /> Height of well casung nser(m inches) <br /> Well cover type 8"or 12"UV 1 T,EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General <br /> -- ti n 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—Lx— <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 Time �"" Calculated purge 16. <br /> . Depth of well 6 Depth to water _ Actual purge A :,! <br /> Depth to water <br /> Start purge -•- Sampling time p� / <br /> Time Temperature E C H Turbidity Volume <br /> 1 <br /> 1 <br /> A <br /> Sample appearance Lock � + S 'may <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 /> Signature <br />