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1 <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar Sampling Date ` C <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation /%,I t.cv — <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> is there standing water in the well box? WoS Above TOC Below TOC <br /> Is top of casing cut level? NO Y If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover we 8" or 12"UV 12"EMCO 8" or 12"BK 8"Christy <br /> 12" Chnsry 8" M&D 12"M&D 12"DWP <br /> l2" CNI 36"CNI 12"Porneco Other M / <br /> General condition of wellhead assembly Excellent Good__2, Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer X Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" _ 4" 6" g?, <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> Irutial Measurement Recharge Measurement <br /> Time : 0 Time q = Y D Calculated purge <br /> Depth of well / Depth to water Actual purge <br /> Depth to water t <br /> Start purge C7 D Sampling time <br /> Time Temperature E C pH Turbidit Volume <br /> l -7 o 0 7 _ <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/I6 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />