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7` a <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No ' <br /> 1210 E Hammer Lane 1400 Well Designation fA- -- <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? ULb VTZQ Above FOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) —tl <br /> Well cover type 8"or 12"LTV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsry8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Porneco '54 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 Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6„ 811 <br /> Purge Vol Multiplier 16 <br /> p —T-65 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time /p -/ ~ Time Calculated purge J �� <br /> Depth of well _ </ q V Depth to water Actual purge <br /> Depth to water r7.5� <br /> Start purge Sampling time ; <br /> ffTem erature E C �/] HTurbidity Volume <br /> ) � ~ l � FE <br /> /9-1 S g' '7 a 9 - <br /> Sample appearance > Lock / jt <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 />