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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling Date <br /> Site Beacon#3641 Protect No <br /> • 1210 E Hammer Lane 1400 Well Designation <br /> _ Stockton Ca <br /> Is setup of tri is control devices required YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If 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"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailerSubmersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centnfugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" $" <br /> Purge Vol Multiplier 0 16 0 65 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time C� Time %Wa�- Calculated purge , <br /> • Depth of well Depth to water Actual purge S". <br /> Depth to water G <br /> Start purge 0 Sampling time d C <br /> Time Temperature E C pH Turbidrt Volume <br /> /01 <br /> 3 Z <br /> Sample appearance � Lock 6 �'"✓ <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 /> i <br /> Signature <br />