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0 ph top <br /> e <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date F5— �67 — <br /> Site Beacon #3641 Project No - <br /> 1210 E Hammer Lane1400 Well Designation /'`'L IA/ _ r] <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level? NO 52!1� If no, see remarks <br /> Is well cap sealed and locked? 3 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 ' Chrisry <br /> 12 ' Chnsry8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Porneco Other l f <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" SVG 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', / q Time Calculated purge s L� <br /> + Depth of well ri`- �� Depth to water Actual purge 7 <br /> Depth to water S. <br /> Start purge 6 Sampling time S <br /> Time Tem erature EC 2H Turbidity Volume <br /> -7d - o 0 <br /> Sample appearance _ C � Lock <br /> Equipment replacer! (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 />