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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Otramar Sampling Daty: ,3''3 <br /> Site: Beacon #3641 Project No,: <br /> 1.210 E.Hammer LaneI400 Well Designation_: M w <br /> Stockton Ca. <br /> Is setup of traffic control devices required?' /1* YES time: ;)roars <br /> Is there standing water in the well box? S Above TOC :Below TOC <br /> Is top of casing cut level? 101 <br /> If no, see remarks <br /> Is well cap sealed and locked? /D NO $ If no, see remarkq <br /> Height of well casing riser(in inches): r <br /> Well cover type: 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D� 12"M&D 12"D" <br /> 12"CM 36" M12"Pomeco Other: <br /> Gcnpral condition of wellhead ass.cmbly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer S> bmersible pump <br /> 2" PVC bailer. Dedicated bailer <br /> 4"PVC bailer . Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Dispos4ble Tubing` <br /> Well Diameter: 2" 4"_ 6" g» <br /> Purge Vol. Multiplier: 0.16. 0.65 1.4— 2.61 gal/ft, <br /> Initial Measurement Recharge Measurement <br /> Time: q 3 5Time. It: O 6, Calculated purge; 5 oO <br /> Depth of well: `� • 6 Depth to water: 3 <br /> P Actu�I purge: 5 <br /> Depth to water: 0 y y <br /> Start purge: ' 6 Sampling time; r= '07 <br /> Time Tem erature E.C. H - Turbidi Volume <br /> Cr 7- 10 2- <br /> 0 r V l! (/ <br /> , 43 64 . 2 63 `f 7 -/5 <br /> Sample appearance: Lock: <br /> Equipment replaced: (check all that apply) Note condition of repl'ac'ed item(s) <br /> 2"Locking Cap: Lock: 7/32 AlIenhead: <br /> 4"Locking Cap: Lock-Dolphin; 9/16 Bolt: <br /> 6"Locking,Cap: Pinned Allenhead (DWP): t <br /> Remarks: <br /> Signature; <br />