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� �—..-+�.- .�.ty!►r++r (wows-+s+..r., .. :-��..y....:.r �. � - <br /> DOULOS ENVIRONMENT, , INC. SAMPLINL 24FORMATION SHEET <br /> Client Ultramar Sampling Date 3`� <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation V w — 7 <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 levels O If no, see remarks <br /> Is well cap sealed and locked9 NO 165. e If no, see remarks <br /> Height of well casing riser(in inches) ( <br /> Well cover type 8"or 12"W 1J"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 36" C'NI 12"Pomeco Other <br /> �- Gecrl condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2" FVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" F <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> lrutial Measurement Recharge Measurement <br /> Time / Time 2 = y D Calculated purge 7 ° 1? <br /> • Depth of well • Og Depth to water Lr . 65— Actual purge 6 <br /> Depth to water <br /> Start purge j Sampling time <br /> Time Temperature E C 2H Turbidity Volume <br /> . 96 7 � & <br /> 2 16 6 " ( L< - 33 z <br /> Sample appearance1X��_�.� 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 />