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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 0-;r7-03 <br /> • Site Beacon #3641 Project No - <br /> 1210 E Hammer Lane1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water m the well boxy ES Above TOC Below TOC <br /> Is top of casing cut levels NO , If no,see remarks <br /> Is well cap sealed and locked? /�y NO 1� if no,see remarks <br /> Height of well casing riser(in inches) /V <br /> Well cover type 8"or 12"UV 12" EMCO 8"or 12"BK 8" Christy <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI I2"Porneco Other <br /> General condition of wellhead assembly Excellent Good Fau 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 P Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 16 065 147 2 61 gal/ft <br /> Imtial Measurement Recharge Measurement <br /> Time •S 41 Time Calculated purge <br /> Depth of well el jfd Depth to water Actual purge <br /> Depth to water C,/5t 3 a <br /> Start purge Sampling time <br /> Time Temperature EC pH Turbidity_ Volume <br /> Sample appearance Lock 8 <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks <br /> Signature <br />