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` DOULOS ENVIRONMENTAL, INC, SAMPLING INFORIMATION SHEET <br /> Client Ultramar Sampling Date �+ i =' <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> ''• � G <br /> Stockton Ca <br /> Is setup of traffic control devices required? N' YES <br /> Is there standing water in the well box9 time hours <br /> Is top of casing cut leveig NO YES Above TOC Below TOC <br /> Is well cap sealed and locked NO YES If no, see remarks <br /> NO YES If no, see remark; <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12" UV 12" EMCO 8"or 12"BIC <br /> 12" Christy 8"M&D 12"M&D 8"Christy <br /> 12"CNI 1� DWp <br /> 36"CNI I2" Fomeco Other <br /> General condition of wellhead assembly Excellent Good <br /> Fair Poor <br /> Purging Equipment 2" disposable bailer <br /> Submersible pump <br /> 2" PVC bailer <br /> 4"PVC bailer Dedicated bailer Sampled with Disposable bailer-� Teflon bailer Centnfugal pump <br /> Disposable Tubing <br /> Well Diameter 2" 4'> <br /> 6„ 8„ <br /> Purge Vol Multiplier 0 16 065 1 47 <br /> Initial Measurement 261 -al/ftRechar e Measurement <br /> Time r/: .1 G Time f Calculated purge / <br /> Depth of well Depth to water <br /> Depth to water 7 Actual purge / <br /> Start purge f - 8�' Sampling time <br /> Time Tem erature E C H Turbiditti Volume <br /> 3C <br /> Sample appearance r ��' Lock <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 9116 Bolt <br /> 6"Locking Cap Pinned Allenhead (D��,-P) <br /> Remarks � <br /> Signature <br />