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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: `q 'd <br /> Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane 1400 Well Designation: �/,I <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 cul level? NO J If no, see remarks <br /> Is well cap sealed and locked? /O NO If no, see remarks <br /> Height of well casing riser(in inches): <br /> Well cover type: 8"or 12"UY 12"EMCO 8"or 12"BK 8" Christy <br /> 12"Christy8"M&D12"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"� " <br /> _ 6" S <br /> Purge Vol. Multiplier: 0,16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement _Recharge Measurement <br /> Time: 7 i y Time: 6) =Z3 Calculated purge: 0 <br /> Depth of well: 7.2 • �� Depth to water: Actual purge: Q <br /> Depth to water: S 7. 177 <br /> Start purge: = Sampling time: R Z 5 <br /> Time Temperature E.C. pH Turbidity Volume <br /> R : l0 3 • <br /> 52- 2- , 56 <br /> 9' � a • �l 2 <br /> R = '71/. o y2o 7 . 35 3 <br /> 7 y • � �f�6 7. 3G y <br /> Sample appearance: czig& Lock: <br /> - <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 /> r <br /> Signature: <br /> i <br /> i <br />