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... r.. a r-, .. .vim• .... ........,.aaaa+..,e�wi to w.,P-+RL'l-a , <br /> DOULOS ENVIRONMENT INC. SAMPLIN4 ANFORMATION SHEET <br /> Client Ultramar Sampling Date 3 <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation M t^' 9 <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut leveh ;06 If no, see remarks <br /> Is well cap sealed and locked9 3 NO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8" Chmty <br /> 12"Chnsry 8" M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General 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 Centnfugal pump <br /> Sampled with Disposable bailer�S P Teflon bailer Disposable Tubing <br /> Well Diameter 2" Y\, 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time _ <br /> 11 Q_� Q Time I , 2 I Calculated purge <br /> iDepth of well Depth to water Q Actual purge _i( 6 <br /> Depth to water y t{ '7,5-7 <br /> Start purge Sampling time Z <br /> Time Temperature EC pH Turbidity Volume <br /> 1 ?- ' 16 � B -Z"' `'l o - � r <br /> ( l� <br /> Sample appearance Lock L�-- <br /> Equipment replaced (check all that apply) Note condition of reg aced 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 /> S i gnature <br />