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°' -- —.....-......,.� �rwy*s..,.r+tiww•.M..... �....�..�..., .- _ �__.....,.�. .c 1arrxtlr.e�.�r�,ar-;�- - <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORIYIATION SHEET <br /> Client Ultramar Sampling Date - f : o� <br /> . Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation /o 'er' r 3 <br /> Stockton,Ca - - -_ <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well box) NO YES Above TOC Below TOC <br /> Is top of casing cut level? NO S> If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) _f_/ D <br /> Well cover type 8"or 12"UV 12" EMCO 8"or 12"BK_,K_ ' Christy <br /> 12" Christy 8" M&D 12"M&D 12'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 k_ Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfugal pump <br /> Sampled with Disposable bailer ,e' Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" ".' 6" 8 <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time I O ' 3 S Time 0-L Calculated purge <br /> Depth of well 7�( �/� Depth to water S Y el Actual purge <br /> Depth to water SI - - <br /> Start purge 11 S / Sampling time IG" 4 57 <br /> Time Temperature E C pH Turbidity Volume <br /> Sample appearance Lock A , <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 />