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DOULOS ENVIRONMENT,- INC. SAMPLING 1FORMATION SHEET <br /> Client Ultramar Sampling Date rd <br /> Site Beacon #3641 Project No <br /> 121• E Hammer Lane 1400 Well Designation /'-I w " <br /> Stockton,Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? I NO � If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in ranches) <br /> Well cover type 8" or 12"UV 12"EMCO 8" or 12"BK 8"Christy <br /> 12" Chesty 8"M&D 12"M&D 12"DWP ' <br /> 12" CNI _ 36"CM 12"Pomeco Other <br /> Gener�,4 condition of wellhead assembly Excellent Good_ Fair Poor <br /> Purging Equipment 2" disposable bailer X Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer X,_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time I : �2- O Time 1 I "�'s Calculated purge <br /> . Depth of well Ss• 006 Depth to water 3 • Actual purge <br /> Depth to water - t9 <br /> Start purge j 2 b Sampling time <br /> Time Temperature E C H Turbidity Volume <br /> 77 <br /> .. 0 <br /> -7 o Z <br /> I L 7 . 7 3 <br /> 3 0 �f <br /> Sample appearance Lock <br /> Equipment replaced (check all that appl 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 (DWT) <br /> • Remarks <br /> Signature <br />