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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Be '`R <br /> a #3641 Project No <br /> I210 E Hammer Lane1400 Well Designation /yZ <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 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) 13 <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chesty 8"M&D 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 Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing—IX— <br /> Well Diameter 2" y 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time �QJ 2 _ Time —f Calculated purge <br /> Depth of well - S-Q ,r� Depth to water Actual purge <br /> Depth to water—3:= ` <br /> Start purge _ Z. 4ED Sampling time <br /> Time Temperature E C PH Turbidity Volume <br /> 2 z <br /> Sample appearance Lock ^ frt� <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 4/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWT) <br /> Remarks <br /> Signature <br />