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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> I210 E Hammer Lane 1400 Well Designation 'Z <br /> f <br /> Stockton,Ca <br /> Is setup of traffic control devices required7 6D YES time hours <br /> Is there standing water in the well box9 Y Above TOC Below TOC <br /> Is top of casing cut level? 0 If no,see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) * /n <br /> Well cover type 8" or 12" UV 12" EMCO 8" or 12" BK 8 'Chrisry <br /> 12" Chnsry 8"M&D 12"M&D 12' DWP <br /> 12"CNI 36" CNI 12" Pomeco Other <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-_TO _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time -10-30 Time Calculated purge s�� <br /> Depth of well 2z e/ic Depth to water Actual purge <br /> t Depth to water <br /> Start purge / 2 Sampling time <br /> I <br /> Time Temperature E C pH Turbidity Volume <br /> 12-'OC / K. 2 S 9 S 66-6 �---�- r <br /> z-•�� 19.7 G_ 6 3 <br /> 2:0 goo S�' f� 6 = 6� Y <br /> Sample appearance _ Y LockPo JPh l✓ <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 /> iRemarks <br /> 5 <br /> Signature <br />