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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date ` /6 - 4 <br /> Site Beacon #3641 Project No <br /> 12 10 E Hammer Lane 1400 Well Designationy <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water to the well box? _0 YES Above TOC Below TOC <br /> Is top of cassng cut levels NO If no, see remarks <br /> Is well cap sealed and locked? y NO If no, see remarks <br /> Height of well casing riser (Ln inches) <br /> Fell cover r}Pe 8" or 12" UV 12" EMCO 8" or 12"BK 8 Christy <br /> 2 ' Chnsty 8" M&D 12" M&D 12"DWP <br /> 12 'Clv'I _�� 36" CNI 12" Porneco Other <br /> General condition of wellhead assembly Excellent Good- )�_ Fair Poor <br /> Purging Equipment X ^2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfugal pump <br /> Sampled with Disposable bailer XTeflon bailer 'Disposable Tubing <br /> Well Diameter 2"1_ 4" 6" 8„ <br /> "urge Vol Multiplier 0 16 065 1 47 2 61gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time lC S 7 Time ' 06 Calculated purge � <br /> Depth of well Depth to water , 36 Actual purge 69 - <br /> Depth to water <br /> Start purge - Sampling time 3 07 <br /> Time Temperature E C pH Turbidity Volume <br /> 7 3 -7 V 7 - 3 1 I <br /> • Y -711 -7 <br /> Tfoo <br /> L <br /> Sample appearance Lock <br /> l <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 91I6 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks t <br /> Signature <br />