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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> , r <br /> Site: Beacon#3641 Project No.: <br /> 'f 1210 E.Hammer Lane 1400 Well Designation: /`I <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? NO If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches): . 3 <br /> Well cover type: 8"or 12"LTV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&cD 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 0.65 1.47 2.61g al/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 1"0 : 2 7 Time: // = Y Z Calculated purge: y <br /> Depth of well: S S -_�_ 7 Depth to water: -Bd Actual purge: . o <br /> =- <br /> Depth to water: Y 7 1 <br /> Start purge: • 3 i� Sampling time: <br /> Time Temperature E.C. pH Turbidi Volume <br /> l =3 7a ' <br /> r , <br /> r , . 3 dd �� � • s C� 3 <br /> Sample appearance: Lock: t-tip <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 /> :3 <br /> Signature: <br />