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- <br /> DOULOS ENVIRONMENTAL, INC. ti SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 4 I•; .00.0 ~' <br /> Site Beacon 43641 Project No ` <br /> 1210 E Hammer Lane1400 Well Designation _/��ti✓`,6 <br /> Stockt_on,Ca Y <br /> Is setup of traffic control devices requued9 YES time hours <br /> Is there standing water in the well boxy YES Above TQC Below TQC <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 riser(in inches) 3 <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 /_2!!� e—-1 <br /> General condition of wellhead assembly Excellent Good. Fair Poor <br /> h <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—5-L_ Teflon bailer Disposable Tubing <br /> Well Diameter 2"�� 411 6" 81, <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time / :19 Time Calculated purge <br /> Depth of well 4 6 Depth to water Actual purge iz-. <br /> Depth to water L/ �-Z 2� <br /> Start purge f`�...5�� Sampling time ` <br /> PS-3 <br /> Temperature EC H Turbidit Volume <br /> � <br /> Sample appearance C: ,�! Lock D olPht� <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 (DWT) <br /> . Remarks <br /> Signature <br />