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��..� t oe.+�-.a +.... "ww'r�.ari�h4 •�7tAWq�o��als.n.- <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 61 <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane 1400 Well Designation M V. — <br /> Stockton:Ca <br /> Is setup of traffic control devices requtredg YES time hours <br /> Is there standing water in the well boxyYE Above TOC Below TOC <br /> Is top of casing cut level9 NO -I ESS If no, see remarks <br /> Is well cap sealed and locked? r NO ES If no, see remarks <br /> Height of well casing riser(in Inches) <br /> Well cover type 8"or 12" W 12"EMCO 8"or 12" BK 8 ' Chrisry <br /> 12" Chnsry 8"M&D 12"M&D 12"DW? <br /> 12 ' CNI 36" CNI 12"Pomeco_rY— Other <br /> General condition of wellhead assembly Excellent Good_ Farr 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" X_ 4" 6" 8" <br /> Purge Vol Multiplier 0 I6 065 1 47 2 61 gaUft <br /> lrutial Measurement Recharge Measurement <br /> Time _ ? OTime f l ' 3 4 Calculated purge , <br /> Depth of well 7/ 7� Depth to water �� 3 4 Actual purge j <br /> Depth to water s 0 /z T_ <br /> Start purge I l ' � I Sampling time t l 3 r <br /> Time Temperature E C pH Turbidity Volume <br /> rt - 21 o" <br /> I . 24 7 V <br /> Ll <br /> Sample appearance �� L�i�,l LockG�'�r�'f�,, ,��r� <br /> r <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />