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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation <br /> _ Stockton,Ca <br /> Is setup of traffic control devices required? NO YES time hours <br /> Is there standing water in the well boat? 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 F Poor <br /> I , <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 0 16 0 55 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time Calculated purge <br /> • Depth of well t Depth to water - Actual purge ` <br /> Depth to water //S . <br /> Start purge ` _ �{ Sampling time <br /> Time Temperature E C pH Turbiditv I Volume <br /> ,6 <br /> Sample appearance ' t-� Lock Fd <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />