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' nr — --.. .-. srMayew.u�+wwnR�M�+►wwM#aevt"7c�0R7�4�F�Paet�"•" <br /> 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 <br /> Stockton,Ca <br /> Is setup of traffic control devices required9 YES tune hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing nser(in inches) <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 condhtion of wellhead assembly Excellent Good_ Fau 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 016 065 1 47 2 61 gal/ft <br /> Irutial Measurement Recharge Measurement <br /> Time �, Time ___A f 4) Calculated purge <br /> Depth of well 5 5 0 G Depth to water 7- /Q Actual purge 7 � <br /> Depth to water 93 - <br /> Start purge 8 ' / 0 Sampling time ' <br /> Time Temperature ur i ity olume <br /> 8 � �l o 68v <br /> Sample appearance Lock y <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />