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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: - -O <br /> Site; Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: 4Au,.-, — 7 <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top of casing cut level? NO a If no, see remarks <br /> Is well cap sealed and locked? NO e5p If no, see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8" or 12"UV 12"ENfCO 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 /> Gencraf 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" g" <br /> Purge Vol, Multiplier: 0.16 0.65 1,47 2.61 gal/ft, <br /> Initial Measurement Recharge Measurement <br /> Time: C % Zd Time: /0 Calculated purge: - <br /> (=_ Depth of well: S y-3 C/ Depth to water: $® • 7D Actual purge: _ • -] <br /> Depth to water: 570-/ <br /> Start purge: 10 3 Sampling time: gyp ' <br /> ,1Time Temperature E.C. pH Turbidi Volume <br /> )0 '� U 7o • j ' God <br /> 10 - 3 cl 17 <br /> � <br /> D - !. y 5 - 70 �l <br /> Sample appearance: ri►w 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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: ' <br /> Signature: <br />