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t y <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date C` ' O <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <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 level9 NO � If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) - / 0 <br /> Well cover We 8"or 12"W 12"EMCO 8"or 12"BK 8" Chrisry <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> I 36"CNI 12"Porneco Other <br /> G e I condnon 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 X CentnfugaI pump <br /> Sampled with Disposable bailer�X 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 /> Imnal Measurement Recharge Measurement <br /> Time _ G = 33 Time � t ' q0 Calculated purge - <br /> Depth of well Depth to water Y C- • Actual purge <br /> Depth to water t( S 1 4 <br /> Start purge - G Sampling time <br /> Time Tempe rature EC pH Turbidity Volume <br /> l � g1 <br /> U )1 - 9 LAS 1 - 14 J <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> 4 <br /> Signature <br />