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^f �,..��. Mpent.,n w.•�. v.w ..'�•.+."*""'^ ...�„-,. . .w k........r......w'4frnrFGOI,�I�-�C'ea's+l�'s�. <br /> I <br /> DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> ■r�il�ll ��� <br /> Client Ultramar Sampling Date q <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation V W , J <br /> Stockton,Ca__ ___ <br /> Is soup of traffic control devices required? YES time hours <br /> Is there standing water to the well box? YES Above TOC Below TOC <br /> Is top of casing cut levels O If no, see remarks <br /> Is well cap sealed and lockedl NO If no, see rernarks <br /> Height of well casing riser(in inches) <br /> Well cover rype 8 or 12" UV 12"EMCO 8" or 12" BK 8 Christ' <br /> 12 ' Chnsty 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 X Teflon bailer -Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gallft <br /> Initial Measurement Recharge Measurement 44 <br /> Time /ro o 3 Time 3 = Calculated puree L . <br /> Depth of well 5 - 9 d Depth to water �/• Actual purge <br /> Depth to water D <br /> Start purge 1 S Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> = 1 73 - 6 ' L 7 <br /> (job <br /> 2- <br /> 3 - 19 <br /> 3 . 1 -7 - O 31-11 i "7 • 0 � <br /> 0 -7 X60 -7 - 01 <br /> Sample appearance Lock ��r/f't-'f�i�t�. <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />