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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> �f Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? (�p YES time: hours <br /> Is there standing water in the well box? YES Above TQC Below TOC <br /> Is top of casing cut level? (�pIf no, see remarks <br /> Is well cap 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"tMCO 8"or 12"BK 8"Christy <br /> 12" Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CM 12"Pomeco Other: <br /> General condition of wellhead assembly; Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer. "K Teflon bailer Disposable Tubing <br /> Well Diameter: 2" ��- 4" 6" $" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: q( : Time: JO 2 6 Calculated purge: <br /> Depth of well: 7V- �{ Y Depth to water: 5Y • Actual purge: _ <br /> Depth to water: y q - S <br /> Start purge: D 2 a Sampling time: <br /> Tim�ey Temperature E.C. pH f Turbidity Volume <br /> 10 �r Lam- • _ O 7 I <br /> ; o . s2 71 _ —).© 2 <br /> 10 -S-3 7 2r3 I' O - ti ' <br /> v6 C7 ?I y <br /> Sample.appearance: Lock; pcg <br /> Equipment replaced: (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap: Lock: 7132 Allenhead; <br /> 4"Locking Cap: Lock-Dolphin: 9116 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP); <br /> Remarks: <br /> h <br /> Signature: <br />