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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Wel] Designation: U/ <br /> Stockton.Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top of casing cut level? 0 If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI I2"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 pum <br /> Sampled with: Disposable bailer Teflon baiter Disposable Tubing_ <br /> Well Diameter: 2" 4" 6" $" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: /O : tl YTime: 1 2 17 Calculated purge: <br /> Depth of well: 7 2 .' 6 3 Depth to water: S� - 02 Actual purge: <br /> Depth to water: �� s <br /> �J <br /> Start purge: 2 Sampling time: <br /> Time-1 Temperature E.C. 2H Turbidi Volume <br /> 12 = 30 60 - e9 /0 L( <br /> 12 ' 3S get v � • �j � <br /> � z: ya . � <br /> Sample appearance: Lock: l <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"I.oeking Cap: Pinned Allenhead ()WP): <br /> Remarks: <br /> Signature: <br /> i <br />