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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 .S <br /> Stockton.Ca <br /> Is setup of traffic control devices requued9 OM YES time hours <br /> Is there standing water in the well box9YES Above TQC Below TOC <br /> Is top of casing cut levels If no, see remarks <br /> Is well cap sealed and locked? `f`l U NO If no, see remarks <br /> Height of well casing nser (in inches) <br /> W ell 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 /> .1.2"CNI 36" CNI 12"Pomeco Other <br /> Gerera�condrnon 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 Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2"_ 5/1 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gaUfl <br /> initial Measurement Recharge Measurement <br /> Time G �0 Time 0 Calculated purge <br /> Depth of well 01' 5 Depth to water Actual purge - <br /> Depth to water . '70 <br /> Start purge T y S Sampling time 1 �� <br /> Time Temperature E C pH Turbidity Volume <br /> dA <br /> � 0 ' -7 `7d r � 6a � - � � Z <br /> o : qd t d l `7 - �S <br /> o: "11 5-8 -7 - 10 <br /> Sample appearance 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 Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />