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DOULOS ENVIRONMENTAL, INC, SAMPLING INFORMATION SHEET <br /> Client: Ultramar - Sampling Datta: <br /> Site. Beacon #3(541 Project No : _ <br /> ,. 1210 E.Hammer Lane 1400 Well Designation : /%1 �— <br /> <>s'1 <br /> 4. <br /> Stockton,Ca. <br /> a. <br /> Is setup of traffic control devices required? YES time: _ <br /> _;hours <br /> Is there standing water in the well box? YES Above TOC .Below TOC <br /> Is top of casing out level? 0 �v If no, see remarks <br /> Is well cap scaled and locked? No If no, see remarks <br /> Height of well casing riser(in inches): <br /> Well cover typo: 8"or 12"UV 12" MCO 8"or 12"BK 8" Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CM 36" CNI 12"Pomcco Other: <br /> ocncral condition of wellhead assembly: Excellent Clood Fair Poor <br /> �� . .. <br /> Purging Equipment: ' 2"disposable bailer Sgbmersihle pump <br /> 2" PVC bailer D6dicated bailer <br /> 4"PVC bailer . Ct;ntrifugal pump <br /> Sampled with; Disposable bailer �— Teflon bailer Dispos4ble Tubing. <br /> Well Diameter; 2" 4" 6" <br /> Purge Vol. Multiplier: 0,16. 0.65 <br /> 1.47 ------ <br /> Initial Measurement Recharge Measurement 2,61 gal/ft. <br /> Time: 6= Time: 8 '. 5 CaleulatOd purge: 11 - 6 <br /> Depth of well: 3 5 7 Depth to water: Actuol purge: 6 <br /> Depth to water:, y 7 - ? s <br /> Start purge. 9 = 02? Sampling time: 2? _ <br /> Time Temperature E.C. H , Turbidi. Volume <br /> t <br /> � . ry G�• 1 ,� G y� <br /> r '7- <br /> 2 ; 1 <br /> 2 : 1 r � gf 6c) y ' <br /> ' 3 <br /> Sample appearance: Lock: D <br /> Equipment replaced; (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock. 7/32 A!lenhead: <br /> 4"Locking Cap; Lock-Dolphin 9/116—Bolt: <br /> 6"Locking Cap; Pinned Allenhead <br /> Remarks: <br /> :;; Signature: <br />