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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORNIATION SHEET <br /> Client Ultramar Sampling Date a 6-03 <br /> Site Beacon 93641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation lav— <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES <br /> Is there standing water in the well boxy WSJ YES time hours <br /> Above TQC Below TQC <br /> Is top of casuig cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO Ws" 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"Christy8"M&D 12" M&D 12"DWP <br /> 12"CNI 36"CNI x-_ 12"Pomeca Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> ;* <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" 8„ <br /> Purge Vol Multiplier 0 l6 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time C Time '---� Calculated purge '2 <br /> Depth of well / r Depth to water Actual purge . <br /> Depth to water <br /> T' <br /> Start purge / 7- Q Sampling time l <br /> Time Tem erature E C H Turbidity Volume <br /> Sample appearance _C _�. Lock <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 />