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DOULOS ENVIRONMEN'. L, INC. SAMPLIh— INFORMATION SHEET <br /> Client Ultramar Sampling Date 9 <br /> � Site Beacon#3641 Project No - <br /> 12 10 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 to the well box? YES Above TOC Below TOC <br /> Is top of casing cut levels ro If no,see remarks <br /> Is well cap sealed and locked NO If no,see remarks <br /> Height of well casing user(in inches) _ ( 0 <br /> Well cover type 8"or 12"LTV 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"Pomecoo 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 Centrifugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time _ UTime 12 : -3 °I Calculated purge <br /> . Depth of well 7 r. 76 Depth to water S O Actual purge <br /> Depth to water <br /> Start purge Sampling time <br /> Time Tem erature E C pH Turbidity Volume <br /> 11 77 <br /> z2 <br /> X7 .2 <br /> Sample appearanceLock <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 />