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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No ' <br /> 1210E Hammer Lanel400 Well Designation V w <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? s Above TOC Below TOC <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 casuig riser(in inches) <br /> Well cover type S"or 12"W 12" EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty8" M&D 12"M&D 12"DWP <br /> 36" CNI 12"Pomeco Other <br /> GEra]cond on of wellhead assembly Excellent Good_[ _ 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:W Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 16 = Time Calculated purge ��- <br /> 10) Depth of well S Oct Depth to water Actual purge -O <br /> Depth to water 4�S <br /> Start purge 's�/� _ Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> � O yq 3ey <br /> OS 1 <br /> /�.'f • q (a �o ted/ Z <br /> 5 � <br /> 7 <br /> Sample appearance _ Lock <br /> Equipment replaced (check all that pply) 4 Note gonoftton of replaced,item(s) <br /> 2" Locking Cap V ck 32 AlIenhe_ad. <br /> 4" Locking Cap .x1;� Lock-Dolphin a x;9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) - ...1 <br /> • Remarks <br /> 4 <br /> Signature <br /> fc <br />