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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 LI/ <br /> Stockton Ca <br /> Is setup of traffic control devices reguued7 YES time hours <br /> Is there standing water in the well boxyYES Above TOC Below TOC <br /> Is top of casing cut levels Vb If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(in inches) to <br /> Well cover type 8" or 12"W 12" EMCO 8" or 12"BK 8 ' Chrisry <br /> 12 'Chnsry 8" M&D 12"M&D 12"DWP <br /> qq I 36" CNI 12"Pomeco Other <br /> Gci4Era condition 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" ) , 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 7 . / O Time 10 3 O Calculated purge <br /> Depth of well S- 0 7 Depth to water Actual purge _ <br /> Depth to water <br /> Stan purge 10 , 12 Sampling time 0 . 3 a� <br /> Time Temperature E C H Turbidity Volume <br /> 10 ' 1 7 71 - S1 <br /> fid . Za I � s '7 <br /> o _ � 0 <br /> �o� 2 �� • 3 � � 3 5 <br /> Sample appearance _ �rL�Cad. 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 /> Signature <br />