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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation /"1 w — 3 <br /> Stockton,Ca <br /> Is setup of traffic control devices required O YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level*7 NO If no, see remarks <br /> Is well cap sealed and lockedl ! NO If no, see remarks <br /> Height of well casing riser(in inches) r <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12"BK__1y_s_ 8" Christy <br /> 12" Christy 8" M&D 12"M&D 12"DWP <br /> l2"CNI 36"CNI 12"Pomeco �� Other <br /> General condition of wellhead assembly Excellent Good�L 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 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 /> Initial Measurement Recharge Measurement <br /> Time d ' I f Time 2 . Calculated purge 7 d_ to <br /> Depth of well `] tj qDepth to water Yr., Actual purge O t 0 <br /> Depth to water ((G 10_ <br /> Stan purge S Sampling time 3 7 <br /> Time Temperature E C pH Turbidity Volume <br /> S Z G <br /> 61 <br /> � 2d� <br /> )0 , 0 tf cl <br /> 3a o 3 - <br /> Ll 1 `� - off <br /> O � <br /> Sample appearance Cx�p .��_ Lock sa4:�:� <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 />