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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 V —� <br /> Stockton Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water ui the well boxy 93 YU Above TOC Below TOC <br /> Is top of casing cut lever NO If no, see remarks <br /> Is well cap sealed and lockedl NO E If no,see remarks <br /> Height of well casing riser(in inches) :f-16 <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8" Christy <br /> 12"Christy8"M&D 12"M&D 12'DWP <br /> 12"CNI-- Se 36"CNI 12"Pomeco Other <br /> General coition of wellhead assembly Excellent Good---;,e ;air Poor , <br /> Purging Equipment 2" disposable bailer }C 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" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Iruttal Measurement Recharge Measurement <br /> Time leg :92 Time Calculated purge �. <br /> Depth of well S/_ g Q Depth to water Actual purge <br /> Depth to water G <br /> Start purge f . l S' Sampling time <br /> Time Tem erature E C pH Turbidity Volume <br /> ye <br /> a 27 <br /> Sample appearance .. ^ .T Lock 0 i�✓ <br /> Equipment replaced (check all that apply) - Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap .Tinned Allenhead (DWP) <br /> Remarks �'`� • <br /> Signature <br />