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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No _ <br /> 12I0 E Hammer Lane1400 Well Designation- /--I IA/ p� <br /> Stockton Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well boxy us Above TOC Below TOC <br /> Is top of casing cut lever NOIf no, see remarks <br /> Is well cap sealed and locked? 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"Chnstyr 8"M&D 12"M&D 12"DWP <br /> 12"CNI�Xt 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fatr <br /> ,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- 411 6/5 <br /> 8„ <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measure ent RecharK Measurement <br /> Time Time 4� Calculated purge 7 <br /> Depth of well ! Y'( Actual Depth to water �._- <br /> p purge <br /> Depth to water �4 � , <br /> Start purge �� z Sampling time Z �4 <br /> Time Terri erature E C H Turbidit Volume <br /> -7-?3 <br /> 2 ZS Z zz� <br /> l2 ' ZIA7 1Z <br /> 26 <br /> f ; <br /> R <br /> Sample appearance Lock r.•J <br /> E <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap f Lock 7/32 Allenhead <br /> 4" Locking Cap I Lock-Dolphin 9/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br /> I <br />