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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar Sampling Date ` 2 O <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation V A <br /> Stockton Ca <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well boxy 19 VPQ Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? 2 t/ `rNO If no, see remarks <br /> Height of well casing riser(in inches) T $9 <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty8"M&D 12"M&D 12"DWP <br /> 12"CNI -JW-CNI—_ 12"Pomeco Other <br /> Genera]condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2" disposable bailerSubmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer_�� Teflon bailer Disposable Tubing <br /> Well Diameter 2" _ 4" 6" g" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time / Time 2 —e ' / Z- Calculated purge 2 <br /> Depth of well. ,O' rd Depth to water Z4 .911( Actual purge Depth to water .$ <br /> Start purge Qc SampIing time <br /> Time Tem erature / E C H Turbidit Volume <br /> _ fo <br /> Sample appearance '- Lock �;r �✓ <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock _ 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 4/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> • <br /> Signature <br />