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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 Well Designation: <br /> gn <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? of 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"Christy 8"M&D 12"M&D 12"DWP <br /> 12"GNI 36"CNI I2"Pomeco Other: ` I� <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 /> WellDiameter: 2"_� 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.6I gallft. <br /> Initial Measurement Recharge Measurement <br /> Time: __�o : `f o Time: Z = 2 Calculated purge. s 7 <br /> Depth of well: 1 2 I ' 3 S Depth to water: _ K L7. 9 5 Actual purge: $ <br /> Depth to water: ' S- 1/0 - r <br /> Start purge: I 1 Sampling time: 2 = 2 <br /> Time Temperature E.C. pH Turbidity Volume <br /> 1 210Y 6010 1Z ( v 7.5S , <br /> a2 <br /> e") C10 , 3 1 Gn • 3 � 2 <br /> 2 : r o <br /> Sample appearance: C/t�Gtti Lock: <br /> p pp <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 /> t <br /> Signature: <br /> t <br /> i <br /> f <br />