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DOLTLOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar Sampling Date 112-v2(9 - �- <br /> . Site Beacon #3641 Project No <br /> 1210 E Hammer Lanel400 Well Designation W �s <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 level? NO If no, see remarks <br /> Is well cap sealed and locked? rO 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"Chnsty 8"M&D 12"M&D 1"'DWP <br /> 12"CNI _ 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer X _Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4"PVC bawler Centrifugal pump <br /> Sampled with Disposable bailer _ T,k Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" g)° <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time / � 0.3 Time Calculated purge 0 <br /> • Depth of well Depth to water Actual purge <br /> Depth to water !Z Y T <br /> Start purge Sampling time J 3 r 2 0 <br /> Time Temperature E C pH Turbidity Volume ti <br /> 13'0,0 rSr. 1� 6 B' 0 q � <br /> L/ 't <br /> Sample appearance -- Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead r <br /> 4" Locking Cap Lack-Dolplun 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />