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DOULOS ENVIRONMENT ,, INC. SAMPLIN INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> . Site Beacon#3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required YES tune hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level? NIf no, see remarks <br /> Is well cap sealed and locked NO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8" or 12"UV 12"EMCO 8"or I2"BK 8"Christy <br /> 12"Chnsty 8"M&D 12"M&D :?Z� 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" FVC 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 ' '3 O O Time ) : I b Calculated purge <br /> Depth of well 7 Depth to water '-t C .d 1 Actual purge :2 S,S' <br /> Depth to water w <br /> Start purge 0 Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> 11 1 L02 7 -© r <br /> 1 � = SO 6• a � � � � �•D G <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />