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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET , <br /> Client Ultramar Sampling Date _d3 <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices requzred? YES <br /> Is there standing water m the well boxy Is hours <br /> Is top of casing cut lever YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO If no, see remarks <br /> NO If no, see remarks <br /> Height of well casing riser(m inches) <br /> Well cover type 8"or 12"UV 12"EMCO <br /> 12"Chris $"or 12"BK 8"Christy <br /> ry 8"M&D 12"M&D 12"DWP <br /> I2"CNI <br /> 36" 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair-- <br /> Poor <br /> Purging Equipment 2"disposable bailer <br /> Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> Sampled wi4"PVC bailer Centrifugal pump <br /> th Disposable bailer-- Teflon bailer <br /> Disposable Tubing, <br /> Well Diameter 2" 4" 6" <br /> Purge Vol Multiplier 016 065 1 47 <br /> Initial Measurement Rechar e Measurement 2 61 gal/ft <br /> Time Q 'Z Time - <br /> Depth of well Calculated purge ..� <br /> p `� - Depth to water Actualpurge <br /> Depth to water /d- <br /> Start purge r -rte Sampling time <br /> Time Tem erature E C H Turbidit <br /> Volume <br /> ) 13 <br /> Z 2 2 <br /> Sample appearance Lock---------------- <br /> f�t1 <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 ^ <br /> 6" Locking Cap 9/16 Bolt <br /> Pinned Allenhead (D Wp) <br /> Remarks <br /> Signature <br />