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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling Date <br /> . Site Beacon #3641 Project No <br /> 1210 E Hammer Lane1400Well Designation ` <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water m the well boxy S Above TQC Below TOC <br /> Is top of casing cut level? faIf 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"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty 8"M&D1_ 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 pain <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing` <br /> Weil Diameter 2" 4" 6" 87� <br /> Purge Vol Multiplier 0 16 0 65 1 47 2 61 gal/ft <br /> Measurement Recharge M�ement <br /> Time Time Calculated purge 6� <br /> Depth of well -(So Depth to water purge <br /> e <br /> Depth to water S`" C_ p g <br /> Start purge Sampling time 3 6 <br /> Time Tem erature E C H Turbidit Volume <br /> �/,33 -3 r <br /> Sample appearance Lock �747 lft vv"'- <br /> Equipment <br /> n/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 /> �emarks , <br /> Signature <br />