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DOULOS ENVIRONMENT_ J, INC. SAMPLING _NFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon#3641 Project No <br /> 121• E Hummer Lane 1400 Well Designation V W <br /> Stockton.Ca _ <br /> Is setup of traffic control devices required9 O YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level9 If no, see remarks <br /> Is well cap sealed and locked? ONO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8"or 12"LJV 12"EMCO 8"or I2"BK 8"Chnsty <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> QUI_ — 36"CNI 12"Pomeco Other <br /> Ge erdi 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"�_ 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gallft <br /> Initial Measurement Recharge Measurement <br /> Time _ ] 2 © / Time 3 Calculated purge 3 <br /> . Depth of well E ' 9 1 Depth to water y y O G Actual purge -5 , 4, <br /> Depth to water Q <br /> Start purge s Sampling time <br /> Time Temperature EC pH Turbidity Volume <br /> hyo `7 . 3 <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 />