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DOULOS ENVIRONMENTINC. SAMPLING, INFORMATION <br /> SHEET <br /> Client Ultramar Sampling Date <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 eEm YES Above TOC Below TOC <br /> Is top of casing cut level9 NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(in Inches) <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8" Chnsty <br /> 12" Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other �M <br /> General condition of wellhead assembly Excellent Good—X, 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 016 o65 147 2 61 gal/ft <br /> Initial Measurement Rechar e Measurement <br /> Time -7 ' Z Time = Calculated purge �- <br /> . Depth of well j' �f y d Depth to water q Actual purge <br /> Depth to water y 3 <br /> Start purge 1 Sampling time 3 <br /> Time Temperature EC pH Turbidity Volume <br /> 1r = � y -ls <br /> � 8 • C' I d 1 - ry I- <br /> ri � 2 <br /> 11C-? 6 • � � 3 <br /> II ' 2 ? 6g 2 a9 : 2 -0l <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply) 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 (DWP) <br /> . Remarks <br /> Signature <br />