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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date t�'— ( —0 <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation u. 5 <br /> Stockton,Ca <br /> Is setup of traffic control devices requueV YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level9 NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing nscr(in inches) <br /> Well cover type 8 'Or 12" W 12"EM 0 8"or 12"BK 8 ' Christy <br /> 12" Chnsry8"M&D 12"M&D 12"DWP <br /> 36" CNI 12"Pomeco Other <br /> Gtnehl condinon 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 Centnfugal pump <br /> Sampled with Disposable bailer ^S P Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" X 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time G = Y Time D{ Calculated purge 7 O - <br /> Depth of well 7 3 O Depth to water Actual purge : C - <br /> Depth to water 45 25 <br /> Start purge 0 ' 0 4 Sampling time 0 ' <br /> Time Temperature E C pH Turbidity Volume <br /> D <br /> Oslo <br /> ( Ore <br /> 1 3 / U —7 - 06 3 <br /> O 7 <br /> Sample appearance L��4df Lock <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 Panned Allenhead (DWP) <br /> Remarks <br /> Signature <br />