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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: _ 7 <br /> Site: Beacon #3641 Project No.: <br /> 1210 E.Hammer Lane1400 Well Designation: <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 elm If no, see remarks <br /> Is well cap sealed and locked? fO NO If no, see remarks <br /> Height of well casing riser(in inches): I <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" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 7 - Time: _ 10: 3 O Calculated purge: ' <br /> Depth of well: &I? Depth to water: S Z - O Actual purge: <br /> Depth to water: S 7. 06 <br /> Start purge: f� ' / Sampling time: <br /> Time Temp erature E.C. pH Turbidity Volume <br /> '2 , 2 7 g <br /> /o : 7• � y <br /> Sample appearance: eco Lock: u#��� <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 />