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DOULOS ENVIRONMENT. , INC. SAMPLIN( 4FORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon 43641 Project No <br /> i <br /> • 1210 E Hammer Lane 1400 Well Designation S� f <br /> Stockton.Ca <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well box9YES Above TOC Below TOC <br /> Is top of casing cut levels Vol, OMP If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches) t-)_0 <br /> Well cover type 8" or 12"W 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12" Christy 8"M&D 12"M&D 12"DWP <br /> 36"CNI 12"Pomeco Other <br /> GeWer�l 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 sailer 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/fl <br /> Initial Measurement Recharge Measurement_ <br /> Time J 1 3 r'_ Time / : © 41 Calculated purge ( `{ <br /> . Depth of well S. CJ Depth to water C) Actual purge I y <br /> Depth to water IE <br /> Start purge r 2 4 Sampling time 4 <br /> Time Temperature E C pH Turbidity Volume <br /> • SI <br /> 67 - <br /> 12 = 5 � • Z �-l ! - 2. � � <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 AlIenhead (DWT) <br /> . Remarks <br /> Signature <br />