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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> 01 Client Ultramar Sampling Date <br /> • Site Beacon ##3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> t <br /> Is setup of traffic control devices required9 YES tune hours <br /> Is there standing water in the well boxy W Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(irn 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 /> 12"CM 36"CNI 12"Pomeco Other <br /> General co�ndit on of wellhead assembly Excellent Goo 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 1 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time Calculated purge <br /> . Depth of well 1;570 Depth to water w_ Actual purge e <br /> Depth to water <br /> Start purge Sampling time + ' <br /> Time Temperature E C pH Turbidit Volume ' <br /> 13 • � 20, 3Z5 <br /> r <br /> Sample appearance 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 /> 5 i <br /> Signature <br /> I <br />