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BOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well box9 NO YES Above TOC Below TOC <br /> Is top of casing cut level9 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"Christy8"M&D 12"M&D 17"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 Centnfugal 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/fl <br /> Initial Measurement Recharge Measurement <br /> Time , :; c; Time - Calculated purge C/ Q <br /> Depth of well Depth to water Actual purge t -� <br /> Depth to water C " 1 <br /> Start purge / 2• Sampling time <br /> Time Temperature E C H Turbidity Volume <br /> Sample appearance C 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 Pirmed Allenhead (DWP) <br /> Remarks <br /> Signature <br />