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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar Sampling Date 30.%3 7 <br /> Site Beacon #3641 Protect No / - <br /> 1210 E Hammer Lane1400 Well Designation V <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy 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 nser(in inches) 9 — <br /> Well cover type 8"or 12"UV 19"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 40'CNI R� 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 /> WeII Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement 3 ` <br /> Time :QZ Time — Calculated purge <br /> . Depth of well S G Depth to water Actual purge <br /> Depth to water—z:/3!. G <br /> Start purge f • '� Sampling time •r � <br /> Time Temperature EC pH Turbidity Volume <br /> t � <br /> 1 <br /> Sample appearance -- _ Lock f ? - <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 /> 4 i <br /> Signature <br />