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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: - Beacon#3641 Project No;: <br /> fel 1210 E.Hammer Lane1400 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 out level? NO If no, see remark$ <br /> Is well cep sealed and locked? No If no, see remarks <br /> Height of well casing riser(in inches): . <br /> Well cover type: 8"or 12" UV 12"EMCO 8"or 12"BK 8" Chri4.ty <br /> 12"Christy8"M&D 12"M&D 12.11 D WP <br /> 12"CNI _ 36"CNI 12"Pomcco Other: <br /> Ocnere]condition of wellhead assembly: Excellent Qood_ •Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer- Dt dieated bailer <br /> 4"PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Dispos :ble Tubin9,1��� <br /> Well Diameter: 2" 4" 6" <br /> Purge Vol, Multiplier: 0 6, 0.65 1.4 <br /> Initial Measurement 2.61 gal/ft.Bechar a Measurement <br /> Time: 6`: Time; O : d Calculated purge; <br /> Depth of well; Depth to water; O Actu4I purge: <br /> Depth to water: <br /> Start purge, Sampling time; /4 / <br /> Time Temperature, E.C. H . Turbidi. Volume <br /> ct • 5 6 $ - ?i o 7. p <br /> 3 D 60 , <br /> Sample appearance: Lock; <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7/32 Alienhead: <br /> 4"Locking Cap: Lock-Dolphin:hin: 9 ,16 Boit; <br /> 6"Locking-Cap: Pinned Allenhead (D"): � <br /> Remarks: <br /> Signature: <br /> I <br /> i <br />