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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon#3641 Project No <br /> • 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca ll <br /> Is setup of traffic control devices required? YES <br /> Is there standing water in the well box? tine hours <br /> y S 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"Chesty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 3*'CNI a 12"Pomeco Other <br /> General condinon n of wellhead ass mbl Excellent <br /> Y Good_ Pau 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" g°° <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> TimeTime Calculated purge <br /> . Depth of well 563 Depth to water Actual purge <br /> Depth to water -$Q <br /> Start purge l-r 00 Sampling time .0 <br /> Time Tem erature E C H Turbidit Volume <br /> c)'/ -2 y. C • �5 %� <br /> Sample appearance Lock p �, <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7/32 AIlenhead <br /> 4"Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />