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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation �• <br /> Stockton,Ca <br /> Is setup of traffic control devices requzred9 YES time hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top of casing cut levels OIf 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"Christy8"M&D� 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good--,)f0 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 50—'-- Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 81)— <br /> Purge <br /> „Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ,6 Time Calculated purge <br /> Depth of well Depth to water Actual purge <br /> Depth to water .,3'6 <br /> Start purge 1jt�Y� O Sampling time yo <br /> Time J Tempe ature E C H Turbidit Volume <br /> O : Deo212 <br /> ? el <br /> /© z 91' Z• GFS �/ <br /> Sample appearance Lock __P—Olf <br /> Equipmept replaced (check all that apply) Note condition of replaced item(s) <br /> 2” Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolplun9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWT) <br /> Remarks ' <br /> Signature <br />