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n <br /> _ _........-.wv ,t.�.MYlaF•,i+'w.prr►,r �...� .wwr w,yws�w..,.+r..r+rn ..«r..-ti - .. _... ..mow..-!c+w-.h <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> iSite Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 WeII Designatior w – r7 <br /> Stockton,Ca <br /> Is setup of traffic control devices requLred9 ORD YES time hours <br /> is there standing water m the well boxy YES Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser (in inches) <br /> Well cover type 8 'or 12 ' UV 12" EMCO 8"or 12"BK 8 Chr,s y <br /> 12 Cttnsry 8" M&D 12"M&D i2"DWP <br /> C-,I 11-x^ 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good _ Fatr Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfugal primp <br /> Sampled with Disposable bailer— Teflon bailer 'Disposable Tubing <br /> Well Diameter 2" 4" X 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time0 Time o� = C70 <br /> I V..7� _ Calculated purge <br /> Depth of well 73 - 08 Depth to water S y actual purge S 7 8 <br /> Depth to w ater <br /> -5-0 e6" <br /> Start purge I - i � Sampling time / <br /> Time Tem eramre EC pH Turbidity Volume <br /> ! - `I f) �/ 7 . 36 <br /> -7 J <br /> Sample appearance Lock ���- � �:/',., A1/. <br /> c <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 9;16 Boit <br /> 6" Locking Cap Pinned Allen-head (DWP) <br /> . Remarks f <br /> Signature <br />