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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 1EWell Designation <br /> Stockton Ca <br /> Is setup of traffic control devices requueV NO YES time <br /> Is there standingwater in the well boxy 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 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco 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 Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 811 <br /> Purge Vol Multiplier 7-16 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time Time -�-- Calculated purge <br /> Depth of well '7 <br /> Depth to water — - - Actual purge <br /> Depth to water <br /> Start purge !�- Sampling time 'Jr <br /> Time Temperature E C H Turbidity Volume <br /> -20 <br /> Sample appearance ��2/-�-� c Lock �i ✓l <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 9/16 Bolt <br /> 6" Locking Cap Pinned AIlenhead (DWP) <br /> Remarks � <br /> Signature <br />