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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar Sampling Date <br /> Site Beacon #3641 _ Project No <br /> • 1214 E Hammer Lane 1400 Well Designation /��✓ ' l <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water to the well box? Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked? ty NO E If no,see remarks <br /> Height of well casing riser(in inches) `T I <br /> Well cover type 8"or 12"UV I2"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI J6"CNI -,L 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated hailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" � — 4" 6" T3 <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time ,3. Calculated purge Z V Z- <br /> �Depthof well - � Depth to water �/ Actual purge <br /> Depth to water <br /> Start purge 1 � Z Sampling time <br /> Time Temperature E C H Turbidit Volume <br /> 0l �=ZS zz. S' • � � <br /> 2? <br /> Sample appearance Locke�Ll <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7/32 AIlenhead <br /> 4"Locking Cap Lock-Dolphin 9/16 Boit <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />