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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 Lane1400 Well Designation: W- <br /> Stockton Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? tC �� If no,see remarks <br /> Is well cap sealed and locked? NO ,?�XESJ If no,see remarks <br /> Height of well casing riser(in inches): Lam/ <br /> Well cover type: 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy__yj 8"M&D 12"M&D 12"DWP � <br /> —1-rrCNI y 36"CM 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 pum� <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: 119% S Time: I : 5 � Calculated purge: 3 <br /> Depth of well: 3 1 - YO Depth to water: �? 2 Actual purge: 5 3 <br /> Depth to water: �: 3 <br /> Start purge: 1 Z 6 Sampling time: l - 5 <br /> Time Temperature E.C. 1 pH Turbidity Volume <br /> 1' 33 6l - 3 100 <br /> cl 5 615v G • � C, <br /> 1 " 45 ° g g 30 <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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Signature: <br />