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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon#3641 Project No <br /> 1210E Hammer Lane1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required9 eb D time hours <br /> Is there standing water in the well box? NO Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? :2 // 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"Chnsty 8"M&D� 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Porrieco Other <br /> General condition of wellhead assembly Excellent Oood Fair Poor <br /> Purging Equipment. 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer CentrAgal purr <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing_ <br /> Well Diameter 2" 4" 6" S" <br /> Purge Vol Multiplier 016 0 65 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement �w <br /> Time Time �-- T Calculated purge y <br /> ODepth dwell • 4nQ' Depth to water Actual purge " <br /> Depthtowater <br /> Start purge / Sampling time e <br /> Time Temperature E C pH Turbidity Volume <br /> 7- <br /> 13 ;std _ z s '/0" <br /> Sample appearance C `` � _ 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 (D WP) <br /> �emarks � <br /> a y <br /> Signature <br />