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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date _ �G Oe7-- <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices requtred9 0 YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut levelsS If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8"or 12"W 12" EMCO 8" or 12" BK 8"Christy <br /> 12 'Christy 8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Pomeco Other <br /> General conditi n of wellhead assembly Excellent Good Far Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" FVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer ( Teflon bailer Disposable Tubing <br /> Well Diameter 2" ><1 4" 6" 8" <br /> Purge Vol Multiplier 716 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement _ <br /> Time ;13 Time 3 ' SS Calculated purge <br /> Depth of well .Q Depth to water O O Actual purge 3 <br /> Depth to water O . <br /> Start purge - Sampling time 3 - 5 7 <br /> Time Temperature E C pH Turbidity Volume <br /> 3 = 3 3 � <br /> Sample appearance Lock <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 />