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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar <br /> Sampling Date <br /> • Site Beacon#3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation 'r <br /> Stockton Ca <br /> Is setup of traffic control devices required' ?O: YES nme hours <br /> Is there standirig water in the well box9 N0 YFS Above TOC Below TOC <br /> Is top of casing cut level9 NO 'YES ` If no, see remarks <br /> Is well cap sealed and locked f NO YES If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12" BK 8 , Chrisry <br /> 12" Chnsty8"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 purnp <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 16 065 1 47 2 61 gal/ft <br /> Imtial Measurement Recharge Measurement <br /> Time / /? _ Time - - Calculated purge <br /> Depth of well Depth to water -- - Actual purge <br /> Depth to water 't �� F <br /> Start purge / -) ` Gy Sampling time <br /> r1l <br /> Temperature E C H Turbidity- Volume <br /> 102 <br /> Sample appearance e—,642n - 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 />