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DOULOS ENVIRONMENTAL INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date — �4g ` o <br /> Site Beacon 93641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices requtre0 �07 YES time hours <br /> Is there standing water in the well box? e_ q YES Above TOC Below TOC <br /> Is top of casing cut lever 'NO tgE ;) If no, see remarks <br /> Is well cap sealed and locked? NO d-0,5) If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well co,,er type 8" or 12" UV 12" EMCO 8" or 12"BK 8" Christy <br /> 12 ' Christy8"M&D 12"M&D 12"DWP <br /> 12"C'NI 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 K Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" X 4" 6" 8" <br /> Pure Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement a <br /> Time _/d- ? 3 Time it - VV Calculated purge Q <br /> Depth of wellS 0 4 Depth to water �0 /0 Actual purge <br /> Depth to water Y 1A <br /> Start purge 1 5 Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> ! f - 3h 7 <br /> -, 7 75 o q a 7 - 3 <br /> -70 Ll 7 / S <br /> (j ; 7 � 7S X03 /6 `f <br /> Sample appearance (� Lock yr- ✓' �� <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 (DWT) <br /> Remarks <br /> Signature <br />