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DOULOS ENVIRONMENT 1, INC. SAMPLIN INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> .' Site Beacon #3641 Prglect No <br /> 1210 E Hammer Lane 1400 Well Designation W 3 <br /> Stockton Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well boxy Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked NO If no,see remarks <br /> Height of well casing user(in inches) 15 <br /> Well cover type 8"or 12"W 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 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 /> hutial Measurement Recharge Measurement <br /> Time Time f J = I Calculated purge q <br /> iDepth of well 7 Depth to water / Actual purge l L?, <br /> Depth to water '9 3 • 3 <br /> Start purge D 1 Sampling time = I,? <br /> — <br /> Time Tem erature EC 2H Turbidity Volume <br /> 3 . . Ct ( C) l <br /> r � = 03 66 . 2 g 76 -7 <br /> / . o 990 7 . (Z� <br /> If9 g ) 6 7 • l6 <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks r <br /> 1 <br /> Signature <br />