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DOULOS ENVIRONMENTAL, INC. SAMPLING INFQRMATION SHEET <br /> Client: ltramarSampling Date: 6 16 QS <br /> Site: __Beacon #3641 _ Project No;: <br /> 1210 E.Hammer Lane 1400 Well Designation: M w <br /> Stockton Ca. <br /> Is setup of traffic control devices required?' r 9 YES time: ;hours <br /> _ <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? N0 cl'"YM 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 type: 8"or 12"L(V 12"EMCO 8"or 12"BK 8" Chrig.ty <br /> 12"Christy8"M&D 12"M&D_- 12"DWP` I f <br /> 12"CNI 345" CM 12"Porneco Other: _ <br /> Ocngral condition of wellhead ass.ernt ly-: Excellent Qood Fair Door <br /> 1. <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dddic-ated bailer <br /> 4"PVC bailerContrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Disposable `Iubing <br /> Well Diameter: 2" Z�::_ 4" 6" <br /> Purge Vol. Multiplier: 0.16 0,65 1. — <br /> Initial Measurement Rechar a Measurement 2.61 gal/ft, <br /> Time: Time: <br /> Q Calculate-d purge: <br /> Depth of wel_!: 1 2 Depth to water: Actual purge: o . p <br /> Depth to water: <br /> Startc•ur a - 2O -_ •:��:;.- <br /> p g • --L- Sampling time: <br /> Time Tem erature E.C. pH Turbid! Volume <br /> 0 <br /> 2-6 69,- -6 S <br /> . <br /> 3 5' a cl <br /> 10 5; 01 <br /> /1 = 1el g SI 6 8 7. Y I.P ti"(, <br /> - T <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: 9AI16 Dolt: <br /> 6"Locking-Cap: Pinned All <br /> Looking <br /> (D '): <br /> Remarks: G O vtsC <br /> Signature: ! -! <br />