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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient: Ultramar Sampling Date: <br /> Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Designation: _ /w <br /> Stockton,Ca. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in the well box? Y S 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): <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 /> Ze' <br /> CNI 36"CNI 12"Pomeco Other: <br /> neral condi 'on of wellhead assembly: Excellent Good_ Fair Poor <br /> Purging Equipment: 2`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 <br /> ubing ,Well Diameter: 2" _ 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharize Measurement <br /> Time: q yo Time: I Z - $ d Calculated purge: 3 - 3 <br /> Depth of well: y •8 7 Depth to water: yG- `f Actual purge: <br /> Depth to water: Y 9 - 6 <br /> Start purge: 2 = O Sampling time: 12 5 J <br /> Time Tem erature E.C. pH Turbidity Volume <br /> 70- 0 U 7 - lam <br /> - 3 G7 � <br /> 2 - Y 712 X70 Y <br /> Sample appearance: _ Lock: <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: 9/16 Bolt: <br /> 6"Locking Cap: Pinned Allenhead (DWP): <br /> Remarks: <br /> Y <br /> Signature: <br /> i <br />