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.-�••- A�+KT(�M4�M'VA^F'+M Wr-+' awr �yyry.w�rrw --.• . . t.�_«�ww+Rv Wr fii".GaFSL4P�+lFiT'�.1. <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date C� D <br /> Site Beacon #364I Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices requued7 E� YES time hours <br /> Is there standing water in the well box? M) YE Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO F If no, see remarks <br /> Height ofwell casing user (in inches) O <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12"BK 8 ' Chrisry <br /> 2 Chnsry 8" M&D 12"M&D 12"DWP <br /> �- CTvI 36" CNI 12"Pomeco Other <br /> Genera] 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 X Centnfiigal pump <br /> Sampled with Disposable bailer Teflon bailer. 'Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Iritial Measurement Recharge Measurement - 9 <br /> Time D S Time 3 '-1 Calculated purge v`— <br /> Depth of well vl d 6 Depth to water ZZ - 03 Actual purge <br /> Depth to water > a • -7 <br /> Start purge Sampling time 3 <br /> Time Temperature E C pH Turbidity Volume <br /> 7. 30 z <br /> Sample appearance- Lock <br /> v <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 (DWP) <br /> • Remarks <br /> Signature <br />