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.w..�* _. <br /> DOULOS ENVIRONMENT, , INC. SAMPLINL _NFORMATION SHEET <br /> Client Ultramar Sampling Date 3r <br /> Site Beacon#3641 Project No <br /> 1210 E Hammer Lane1400 Well Designation V W — <br /> Stockton,Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? 9P YES Above TOC Below TOC <br /> Is top of casing cut level's NO If no, see remarks <br /> Is well cap sealed and locked? ' ONO If no, see remarks <br /> Height of well casing riser(iii inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsry <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> y2 �4 36"CNI 12"Pomeco Other <br /> Ge aondition 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" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> hutial Measurement Recharge Measurement <br /> Time J r y 3_ Time �- .` 2 C7 Calculated purge <br /> Depth of well S' f S Depth to water Actual purge <br /> Depth to water Ll <br /> Start purge - 3 Sampling time Z ' <br /> Time Temperature EC pH Turbidity Volume <br /> '- � 6 g U SDI (� 7 • � v � <br /> = 3 � 6-6 2 . .37 <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />