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- --•---� ^",�„�",.�%�-r.•.a..sa.wrta.«,...... ......w,+..�„�,,,.,a..,�... — .- _ .... .« .c.�--a..E-�Sh��-..�-QCs.+- <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client UItramar Sampling Date <br /> . Site Beacon #3641 Project No <br /> I210 E Hammer Lane 1400 Well Designation /-L-1 V.." <br /> Stockton,Ca <br /> Is setup of traffic control devices requuedv YES time hours <br /> Is there standing water to the well box'? YES Above TOC Below TOC <br /> Is top of casing cut level? NOlem If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12" W I2"EMCO 8"or 12" BK 8"Christy- <br /> 12" <br /> hrisryl2"Chrnsty 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 Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer }C Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" g" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time /D ' y0 Time 1 Calculated purge , <br /> Depth of well S �� Depth to water S 7d Actual purge <br /> Depth to water $ Q 0 <br /> Start purge 1 �I Sampling time (vt S 6 <br /> Time Temperature E C pH Turbidity Volume <br /> iso 7 _ Z <br /> Sample appearance Lock <br /> r <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 />