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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 400—. -- <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 NQ' YES time hours <br /> Is there standing water in the well box? 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 locked9 NO YES If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well coNer type 8" or l2"UV 12" EMCO 8"or 12"BK 8"Christy <br /> 12"Chrisry 8" M&D 12"M&D 12"DWP <br /> 12"CNI 1 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair F 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" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time F 0 7_ Time Calculated purge <br /> Depth of well Depth to water --y =_ actual purge "5 <br /> Depth to water 1_/,5 <br /> Start purge _� Sampling time r' <br /> Time Temperature EC 2H <br /> id Turbidity Volume <br /> Sample appearance 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 Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />