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DOULOS ENVIRONMENTAL, INC. SAMPLING�INFORMATION SHEET <br /> Client Ultramar Sampling Date 4z__2 6__01— <br /> Site <br /> otSite Beacon #3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation (.✓` '1 <br /> Stockton Ca <br /> Is sctup of traffic control devices requsred7 YES time hours <br /> Is there standing water m the well boxy S Above TOC Below TOC <br /> Is top of casing cut lever 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) <br /> Well cover type 8" or 12" UV 12"EMCO 8"or 12"BK 8 Christy <br /> 12"Chnsry8" M&D 12"M&D 12 'DWP <br /> 12" CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Farr 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,V Teflon bailer, Disposable Tubing <br /> Well Diameter 2" _ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/f1 <br /> f initial Measurement Recharge Measurement <br /> Time 1,9 :/ 3 Time Calculated purge - 4 <br /> Depth of well Depth to water Actual purge `•1- <br /> Depth to water <br /> Start purge �' �� Sampling time _'/ Z' 3S <br /> L <br /> Time Temperature E C PH Turbidity Volume <br /> 33 /p _S`� Cog �- - ID <br /> Sample appearance Lock +i/ <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 it <br />