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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling DateSite Beacon #3641 Protect No <br /> 1210 E Harnmer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked 1 NO If no, see remarks <br /> Height of well casing riser(in inches) �p <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 <br /> General con in n of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer ' <br /> p 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 Cf 16 0 65 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time l 2 Calculated purge 2 , <br /> Depthof well Depth to water �/ Actual purge <br /> Depth to water Z - <br /> Start purge Z Sampling time <br /> Time Temperature E C H Turbidit Volume <br /> J AL <br /> F/ ZZ, <br /> 75 <br /> Sample appearance Lock p <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 />