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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: - Beacon #3641 Project No : <br /> 1210 E.Hammar Lane1400 Well Designation: Gv -- <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 cot level? NO If no, see remarks <br /> Is well cap sealed and locked? / NC) If no, see remarks <br /> Height of well casing riser(in inches); •O <br /> Well cover type; 8"or 12"UV 12" EMCO 8"or 12"BK 8" Chrilty <br /> 12"Christy8"M&D 12" M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other: <br /> Gongral condition of wellhead ass,ombly: Excellent Good Fair $oor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Cgntrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Dispasdble Thbin � <br /> Well Diameter: 2"_x_ Opp 6" <br /> Purge Vol. Multiplier: 0.16. 0.65 1,47 2,6I gal/ft, <br /> Initial Measurement Recharge Measurement <br /> Time: f' Time: 3 ( Calculated purge; O <br /> Depth of well: 6 7r )B Depth to water: —�`— <br /> P _ . S I • d Actudl purge:_Z a _ <br /> Depth to water: O• � <br /> Start purge: 2? ' 1 Sampling time: <br /> Time Temperawre E.C. H . Turbid. : Volume <br /> #96 <br /> S 7 0 <br /> Sample appearance; C��wLock; <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) G <br /> 2"Locking Cap: Lock: 7132 Aller head: ` <br /> 4��Locking Cap: Lock-Dolphin 4 ;16 Balt: <br /> 6 Locking Cap: Pinned Allenhead (D"): <br /> Remarks: ------------------ <br /> ' <br /> f <br /> r <br /> Signature: <br /> f <br />