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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 11✓ ` <br /> Stockton Ca <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut levels NO <2M <br /> If no,see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(in inches) zo <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNICNI 1 - 12"Pomeco Other <br /> General condition of<�iellhead assembly Excellent Goode 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 ..r Teflon bailer Disposable Tubing <br /> Well Diameter 2" y— 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time L6_A6 Time 2 Calculated purge 45 <br /> • Depth of well , 0-3 Depth to water Actual purge /_ 2.0 <br /> Depth to water O <br /> Start purge Sampling time 457► 04 <br /> Time Tem erature E C pH Turbidit `Volume <br /> q5- qla- <br /> Sample appear- <br /> ;3rice (' �_ Lock :` <br /> r <br /> Equipment replaced (check all that apply) ,fiTot�condition of replaced item(s)- <br /> 2" <br /> tem(s)- <br /> 2" Locking Cap Lock '' 7/32 AlIenhead " <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhe44 (I WP} <br /> Remarks =f <br /> Signature <br />