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ti ��__•----•.+ ifaM'��P•`+F�+�w.r.w.... w.. r ,. �.�-_�...^..r .z 1�1^+tA1!i�l�R'+f77!'-CK_ .. <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? YES Above TOC Below'T'OC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? 3 NO - E If no, see remarks <br /> Height of well casing riser(in inches) <br /> W ell cover type 8"or 12" UV 12"EMCO 8" or 12"BK 8" Christy <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Pomeco 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 tC Centrifugal pump <br /> Sampled with Disposable bailer -X Teflon bailer Disposable Tubing <br /> Well Diameter 2" X 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gaUft <br /> Uutial Measurement Recharge Measurement t f <br /> Time lo : _�_�?_ Time ( ,- ( Calculated purge 1 <br /> Depth of well f �1 l3 Depth to water Actual purge <br /> Depth to water 0"- <br /> Start purge jC C Sampling time <br /> Time Temperature EC 2H Turbidity Volume <br /> Sample appearances Lock 2� <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 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />