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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date t0 <br /> Site Beacon #3641 Project No <br /> 1210.E Hammer LaneI400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required? NOl YES tune hours <br /> Is there standing water in the well box? NC3 YES Above TOC Below TOC <br /> Is top of casing cut lever NO c YES If no, see remarks <br /> Is well cap sealed and locked? NO 'YES If no, see remarks <br /> Height of well casing riser(nn inches) <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12"BK 8" Christy <br /> 12" Chnsty 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 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 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ,f Time Calculated purge �/ cj- <br /> Depth of well Depth to water ._ actual purge <br /> Depth to water _fir/ �-c <br /> Start purge / -�/ Sampling time <br /> Time FTemperature E C nH Turbidity Volume <br /> r, <br /> Sample appearance (f-��u'� 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 />