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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 2 ? d <br /> Site: Beacon#3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: (/ <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? ro OD If no,see remarks <br /> Is well cap sealed and locked? NO lip 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"CrII 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 94— 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 Rechaz a Measurement <br /> Time: 1 I : 0 �L-- Time: 1 '. / 7 Calculated purge: 3 q <br /> Depth of well: •g Depth to water: ycl Actual purge: <br /> r' iy 1 Depth to water: _L _ 6 <br /> Start purge: a Sampling time: 2 : Z. Com.Time /Temperature E.C. H Turbidi Volume <br /> 2 42 / fr 0 T v 1 d� � r 9 <br /> Z . o � � t• 3 lr��d G . � o � 2 <br /> 3. <br /> Sample appearance: 6,14 C4-11/ Lock: i <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 /> I <br /> Signature: i <br /> I <br />