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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lanel 400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water to the well box? S Above TOC Below TOC <br /> Is top of casing cut level9 NO If no, see remarks <br /> Is well cap sealed and locked 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„CMsty 8"M&D 12"M&D 12"DWP <br /> 3f"CIVI 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 /> Well Diameter 2" 4" 6„ $„ <br /> Purge Vol Multiplier 016 065 I 47 2 6I gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time4felli <br /> Time _ Calculated purge <br /> Depth 3„ Depth to water — —�--- Actual purge <br /> Depth to water <br /> Start purge � %'�l Sampling time S <br /> Time Temperature EC /H Turbidi Volume <br /> Z :s' <br /> 3 z z_ �. a �..�--- <br /> 3 � z zC I <br /> Sample appearance Lock _ a 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 (DW?) <br /> Remarks <br /> Signature <br />