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^-----� _ .�,p„F„p,�,.,,..,1,.y,p„...,,...v....-, .,...,..,,,,..,.�■.,�..,�.......Y,.....��.-.. _ �...s ,...,Kv�cr�ti-xxaa_�.,v',+,ws+ <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date - 1 6- O <br /> SSite Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Iss— e�f traffic control devices requrred? YES .'•,._..--. timehours <br /> is <br /> --' <br /> Is there standing water m the well box9 AW Y.ES Above TOC Below TOC <br /> Is top of casing cut level? NO Ylzt If no, see remarks <br /> Is well cap sealed and locked 1 NO If no, see remarks <br /> Height of well casing riser(in inches) 19 <br /> Well cover tv-pe 8 ' or 12" UV 12" EMCO 8" or 12" BK 8 'Chrisry <br /> 12 ' Clinsry 8" M&D 12" M&D 12" DWP <br /> ._42"CNI 36" CNI 12"Pomeco Other <br /> General condition 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_ Teflon bailer •Disposable Tubing <br /> Well Diameter 2" µ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 0 65 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time 16 Time = d Calculated purge <br /> Depth of well -7 n Depth to water GS ya Actual purge <br /> Depth to water 5 ( - o 1 <br /> Start purge �_ /Q Sampling time °1 <br /> Time Temperature EC 2H Turbidity Volurne <br /> f L 1_7 .. . X30 <br /> l 7dol <br /> 540_ _1 <br /> r <br /> Sample appearance Lock c c-4,4 �r-- <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />