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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date Llo-20 ' 3 <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation 'a <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box) I yy4s Above TOC Below TOC <br /> Is top of casing cut level? NO Ya If no, see remarks <br /> Is well cap sealed and locked? NO �''�2` If no, see remarks <br /> Height of well casing riser(ui inches) <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 12"Pomeco Other 4ZI <br /> General condition of wellhead assembly Excellent Good 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" ,y 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time Calculated purge • <br /> • Depth of well Depth to water Actual purge •d <br /> Depth to water , . / <br /> Start purge �K rl 7 Sampling time 2 Z <br /> Time Temperature EC pH Turbidity Volume <br /> •s' <br /> Sample appearance Lock 00/ f <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 /> 0Remarks <br /> Signature <br />