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�r err-- e�.n e•-FVM <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date — <br /> • Site Beacon #3641 Project No <br /> 1210E Hammer Lanel400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required? O YES tune hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO- If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) �"1 <br /> Well cover type 8" or 12"UV 12" EMCO 8"or 12"BK 8" Christy <br /> 12" Chnsry 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 - p -- Teflon bailer Disposable Tubing <br /> Well Diameter 2" '\ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time 6 10 Time O Calculated purge 7 O <br /> Depth of well `] I . 7 ( Depth to water q 3 Actual purge / 7 - 0 <br /> Depth to water t{5 d <br /> Start purge = S > Sampling time O S <br /> Time Temperature E C pH Turbidity Volume <br /> C7 eg <br /> Dv <br /> 11 . 0 7_ oma <br /> 8 L 7 G <br /> Sample appearance C�C_� � Lock .10 <br /> 714 <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 />