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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date r <br /> 0 ' <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane1400 Well Designation /�1�✓ <br /> Stockton,Ca _ <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? Y S Above TOC Below TOC <br /> Is top of casing cut level') NO if no, see remarks <br /> Is well cap sealed and locked? NO S If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 1 MCO 8"or 12"BK 8" Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI,� 36" CM 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goode 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" g„ <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Irutial Measurement Recharge Measurement <br /> Time Time -. Calculated purge <br /> Depth of well ! r9l, Depth to water Actual purge <br /> Depth to water L � z 4 <br /> Start purge Sampling time l <br /> p,Time Temperature E C pH Turbidity Volume <br /> ey <br /> Sample appearance ���'� Lock <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 (DWP) <br /> *Remarks <br /> Signature <br />