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�.....-._ A�T,M•�+K1ky44N,1••,a..w•h w... u+Y.+r..r.w-ti*+ �».r - - ..� .++....r+.c•vrr <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date q_ l6 —_) <br /> SSite Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation 1A <br /> Stockton_,Ca <br /> Is setup of traffic control devices requued? YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level? NO alp If no, see remarks <br /> Is well cap sealed and locked9 NO CYE If no, see remarks <br /> Height of well casing riser(iri inches) <br /> w ell co4er type 8" or 12' UV 12"EMCO 8" or 12"BK 8 Christy <br /> 12 ' Christy 8"M&D 12"M&D—,Z, 12"DWP <br /> I2' CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goody - Fair Poor <br /> Purging Equipment 2" disposable bailer ?'C Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled ith Disposable bailer _ _�F Teflon bailer •Disposable Tubing <br /> Well Diameter 2" 4" �K, 6" g" <br /> Purge Vol M. Ultipl er 016 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time O ' Time / 3 0 _ Calculated purge �� <br /> Depth of well d Depth to water S�• Actual purge S S <br /> Depth to water { / - / <br /> Start purge Sampling time <br /> Time f Temperature E C pH Turbidity Volume <br /> o -709 2 <br /> 7tla j <br /> -71/ <br /> f � <br /> Sample appearance rtes Lock <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> iRemarks k <br /> Signature <br />