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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> • Site Beacon #3641 Project No <br /> 12I0 E Hammer Lane 1400 Well Designationk/- <br /> - Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy fB V FUR Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked -74 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"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 9W'CNI "Z!�4 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good_ Fair Poor <br /> E <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 0 6 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time -/ Time '~------- Calculated purge Z <br /> Depth of well -4 Depth to water -w---~-- Actual purge <br /> Depth to water / <br /> Start purge 2 Sampling time , �g <br /> Time Tem erature E C H Turbidrt Volume <br /> 71 <br /> Sample appearance She• LockO � <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/I6 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />