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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date - �1-d.3 <br /> Site Beacon #3641 Protect No <br /> 1210 E Hamner Lane 1400 Well Designation /qw- 7 <br /> Stockton Ca <br /> Is setup of traffic control devices required? NO YES time hours <br /> Is there standing water <br /> in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? E If no, see remarks <br /> Is well cap sealed and locked NO <br /> Height of well casing riser(m inches) V If no, see remarks <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 /> t 2"CM 36"CNI 12"Pomeco Other <br /> General condition of wellhead assem ly 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---K— <br /> Well Diameter 2" 4" 61F $„ <br /> Purge Vol Multiplier 0 i6 0 65 1 47612 gal/ft <br /> Initial Measurement Rechar a Measurement <br /> Time . 6 Time Calculated purge <br /> to <br /> Depth well Depth to water - Actual e <br /> Depth to water - purge <br /> Start purge Sampling time .'2 1< <br /> Time <br /> Tem erature E C H Turbidit Volume <br /> 1 -3 ,9 V-312. <br /> Z <br /> r <br /> l 4zz z /. � 13g <br /> Sample appearance -�� _ Lock DozoriotAl <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7132 Allenhead <br /> 4"Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />