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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: L3-c> 5 <br /> Site: . Beacon#3641 Project No.; _ <br /> 'i <br /> 1210 E.Hammer Lane1400 Well Designation: M u' r G <br /> Stockton,Ca. <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? NO If no, see remarks <br /> Is well cap sealed and locked? } NO If no, see remarks <br /> Height of well casing riser(in inches): J <br /> Well cover type: 8"or 12"UV 12" EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 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— 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: G1 : / Time: /0 ' 0C Calculated purge: y <br /> Depth of well: •© � Depth to water: _ •_ Actual purge: <br /> Depth to water: ! o <br /> Start purge: q 1 1r �? Sampling time: <br /> Time Temperature E.C. PH Turbidity Volume <br /> /0 .% a c+ ,_ 'DC7 <br /> a 6 2 <br /> 40 to 4- <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: 4/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> f <br /> Remarks: <br /> Signature: <br />