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DOULOS ENVIRONMENTAL, INC. <br /> . SAMPLING INFORMATION SHEET <br /> MOM— <br /> Client: Ultramar _ Sampling Dato; 6'-16— o <br /> Site: Beacon#3641 _ Project No : <br /> 1210 B.Hamrner Lane1400 Well Designation: V ul <br /> r Stockton,Ca, 7 <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? If no, see remarks <br /> Is well cap sealed and locked? NO 1 If no, sce remarks <br /> Height ofwelJ casing riser(in inches); Iy <br /> Well cover type; 8"or 12"UV 12"EMCO 8"or 12"BK 8" Christy <br /> 12" hristy8"M&D 12"M&D 12"DWP <br /> CM 36" CNI I2"Pomeco Other: <br /> Ocn;ral conditao .Of wellhead assembly: Excellent Oaad Fa-if Pcor <br /> Purging Equipment; X 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dr dicated bailer. <br /> _ <br /> 4"PVC bailer Contrifugal pump <br /> Sampled with; DisposabIel bailer Teflon bailer Disposable T11bin <br /> Well Diameter; 2"� 4" 6 g;, <br /> Purge Vol. Multiplier: O,I6 <br /> 0.65 1,47 <br /> Initial Measurement Rec2.61 gal/ft.har a Measuremen# <br /> Time; 7�2 ' <br /> Time: J_ Cep CaIculat0d purge: L� <br /> Depth of well: 5 Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge: /0: Sampling time: O <br /> r: <br /> Time Temperature B.C. pH Turbidi <br /> /d ' Cf G 2 D / Volume <br /> /O. O r VQ � 7 roG <br /> Q 2 y 3 <br /> 0 . <br /> Sample appearance: Lock; 1 t,ti,L <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap; Lock: 7/32 AIlenhead: <br /> 4"Locking Cap: Lock-Dolphin; 9A 6 Balt: <br /> b"Locking-Cap., Pinned Allenhead (DWP,'); <br /> Remarks; <br /> Signature; y <br />