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DOULOS ENVIRONMENI -,, INC. SAMPLIN`,- INFORMATION SHEET <br /> Client Ultramar Sampling Date 3 — —�� <br /> � Site Beacon #3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water to the well box? )14 Above TOC Below TQC <br /> Is top of casing cut level? NO ag If no, see remarks <br /> Is well cap sealed and locked? l C� NO If no, see remarks <br /> Height of well casing user(in inches) a <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 36"CNI 12"Porneco Other <br /> n&al condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer >C Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" P bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" x 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 1 j 1-t 0 Time ( 1 Calculated purge 2 <br /> . Depth of well -79 g Depth to water _ y G •ry Actual purge - <br /> Depth to water 3 l <br /> Start purge r Sampling time C <br /> Time Temperature EC pH Turbidity Volume <br /> - 33 <br /> Sample appearance — 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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />