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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: l Z' Z 1 <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: &I w °� <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? 4 If no,see remarks <br /> Is well cap sealed and locked? G 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"M 12"Pomeco Other: g <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2"disposable bailer >4, 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 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:'__ 10 `.2D Time: It = 1 y Calculated purge: 2 ' <br /> Depth of well: 7'�� Depth to water: t{ . s e;7 Actual purge: <br /> Depth to water: <br /> Start purge: Qq Sampling time: <br /> Time Temperature E.C. pH Turbidity Volume <br /> :rte bl o- <br /> rl= 1 2 <br /> 61 - 1 K &I o <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: 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br /> I <br />