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DOULOS ENVIRONMENT , INC. SAMPLIN` _NFORMATION 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 box? YES Above TOC Below TOC <br /> Is top of casing cut level) NO If no, see remarks <br /> Is well cap sealed and locked? L NO If no, see remarks <br /> Height of well casing riser(in inches) r <br /> Well cover type 8"or 12"LN 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12" Christy 8"M&D 12"M&D 12"DWP <br /> ',�,N I_J� 36"CNI 12"Pomeco Other <br /> Gflfler'al 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 Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" x 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ' S Time 4 Calculated purge <br /> Depth of well ztj Depth to water Actual purge -7 �— <br /> Depth to water <br /> Start purge 1 Sampling time = 3 <br /> Time Temperature EC pH Turbidity Volume <br /> �r 6a2 7 - 1 I L <br /> 6 2 •n <br /> Sample appearance C �" 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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> MRemarks <br /> Signature <br />