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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client; Ultramiir Sampling Date: 3 - • O <br /> Site: Beacon#3641 Project <br /> 1210 E.Hamrrler Lane1400 Well Designation: /v1 tw <br /> Stockton Ca <br /> Is setup of traffic control devices required'?' NO YES time: hours <br /> Is there standing water in the well box? NO YES Above TOC Below TQC <br /> Is top of casing out level? NO YES If no, see remark <br /> Is well cap sealed and locked? NO YES If no, see remarkq <br /> Height of well casing riser(in inches): <br /> Well cover type; 8"or 12"UV 12"EMCO 8"or 12"BK 8" Chrilry <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CM 36" CN7 12"Pomeco Other: <br /> Conal condition.of wellhcad assembly: Excellent Good FeiF Poor_ <br /> Purging equipment: 2" disposable bailer 2 _ Submersible pump <br /> 2." PVC.bailer _DOdicated bailer. <br /> _4"PVC bailer �� Contrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer Disposable 'hlbing <br /> Well Diameter: 2" 4"—�. 6" 8„ <br /> Purge Vol. Multiplier: 0.16. 0.65 1,47 <br /> Initial Measurement 2'61 gal/ft. <br /> Recharge Measurement <br /> Time: °1 ' '30 Time: Calculated purge; +t�� <br /> Depth of well; 7 3• Depth to water; t )Q <br /> Actu4l purge,- <br /> Depth to water: <br /> ' 3 <br /> Stan purge: Gf Sampling time. <br /> Time Tem erature E.C. H . Turbidi. Volume <br /> 11 2 37 At / 7 . 30 I <br /> 6 � 1 - � 6 � 2 .7 . / 7 <br /> rI <br /> , (' , <br /> If 7 7 r <br /> 3 <br /> 6 . 7 . 0cl y <br /> Sample appearance: C-%--t <br /> Lock; <br /> F <br /> Equipment replaced: (check all that apply) Note condition of replat; d item(s) <br /> 2"Locking Cap: Lock: 7/32 Ailenhead: <br /> 4"Locking Cap: Lock-Dolphin: <br /> 9A_6 Bolt: <br /> 6"Locking-Cap: Pinned Allenhead (D"): <br /> Remarks: <br /> Signature: <br />