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t <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> iSite Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation /4�_,\ W r <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level? NO gTM If no,see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) 49 <br /> Well cover type 8" or 12"UV 12" EMCO 8"or 12" BK 8 'Chrisry <br /> 12" Chnsry 8" M&D 12"M&D_ 12" DWP <br /> 12" CNI 36" CNI 12"Pomeco Other <br /> Gencral condinon of wellhead assembly Excellent Good Fau Poor <br /> Purging Equipment 2" disposable bailer X Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer S Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4"�� 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gallft <br /> Irutial Measurement Recharge Measurement <br /> Time G ;_ O Time Q Calculated purge <br /> Depth of well 7.z • e/2 Depth to water 46 Actual purge 6 <br /> Depth to water y 6 _A <br /> Stan purge P, 0 Sampling time 15Y <br /> Time Temperature E C pH Turbidity Volume <br /> Ir <br /> R C2 901 1 7 ,00 <br /> � Ig � l • � � � - �v `f <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 />