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DOULOS ENVIRONMEN'_ L, INC. SAMPLIN__ INFORMATION SHEET <br /> Client Ultramar Sampling Date 2 <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 level? NO MD If no,see remarks <br /> Is well cap sealed and locked? �� NO If no, see remarks <br /> Height of well casuig nser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12" Chnsty 8"M&D 12"M&D 12"DWP <br /> �� 36"CNI 12"Pomeco Other <br /> r l <br /> G con_2��non 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" X,, 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time _ 1 r _ 3Time I2 = Calculated purge -7 7 _ <br /> . Depth of well `7 3 Depth to water OS Actual purge -7 7 <br /> Depth to water Lf3 • 1 <br /> Start purge 2 = 0 Sampling time <br /> Time Tem erature EC pH TurbidijX Volume <br /> Cl Cl lull <br /> � 2 34 �'g • 2 893 � •� o <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 /> Signature <br />