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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date (D r <br /> Site Beacon #3641 Project No ^ <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices requireV NO YES <br /> Is there standingwater in the well boxy time hours <br /> NO YES Above TOC Below TOC <br /> Is top of casing cut level? NO YES If no, see remarks <br /> Is well cap sealed and locked NO YES 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 .2"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> r <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" 41• 6" 8„ <br /> Purge Vol Multiplier 0 16 0 65 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time "� Time --- Calculated purge <br /> Depth of well Depth to water �•-- <br /> Depth to water Actual purge <br /> �;. 1 <br /> Start purge 0:5-, Sampling time / • " <br /> Time Tem erature E Cf H Turbidity %'olume <br /> r <br /> = n9 S 2I -7. 0 �/ <br /> Sample appearance 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 Pinned11A ennead (DWP) <br /> Remarks � <br /> Signature <br />