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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date - G;z 3 <br /> - Site Beacon#3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation V r <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water to the well box? O 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 qMS 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"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 3f' CNI 12"Pomeco Other <br /> General condition of wellhead ass mbly Excellent Good, Fair Poor <br /> purging Equipment 2" disposable bailer ' <br /> 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" 833 <br /> Purge Vol Multiplier 0 16 0 65 1 47 —1-6 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Z Time +p t� - Calculated purge <br /> Depth of well Depth to water �. ,3 Actual purge <br /> Depth to water —e--1 <br /> Start purge Sampling time / 3 6 <br /> Time Tem erature E C H Turbidit Volume <br /> Z 59 2 S- <br /> Sample appearance Lock O <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 />