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r <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3541 Project No <br /> 12I0 E Hammer Lane 1400 Well Designation V ty S <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 T If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(in inches) `f`( 0 <br /> Well cover we 8" or 12"UV 12" EMCO 8"or 12" BK 8" Christy <br /> 12" Chnsry8"M&D 12"M&D 12"DWP <br /> �CCV� 36"cNl 12"Pomcco Other <br /> Ge a on itlon of wellhead assembly Excellent GoodFair 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 0 16 065 147 2 61 gal/ft <br /> lrutial Measurement Rechar e Measurement <br /> Time 7 o 3 Time / • / 0 Calculated purge <br /> Depth of well Depth to water of . d 3 Actual purge <br /> Depth to water Y S - tl 2 <br /> Start purge l a I s Sampling time <br /> Time Temperature E C pH Turbidity Volume <br /> lo� S3 <br /> � o '- s 7 � • 6 6 �1s -?- <br /> � o :�s <br /> /0� 7 / - 9 CO2 -7 - 16 <br /> Sample appearance _ C — c�v. 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 AlIenhead (DWP) <br /> Remarks <br /> Signature <br />