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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon 93641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation O!LA w — <br /> Stockton,Ca_ <br /> Is setup of traffic control devices required 611ZP, YES time hours <br /> Is there standing water in the well boxy CNW YES Above TOC Below TOC <br /> Is top of casung cut level? NO If no, see remarks <br /> Is well cap sealed and locked9 �p NO E If no, see remarks <br /> Height of u ell casing riser(inn inches) * 1 Q <br /> Well co.er We 8" or 12" W 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good-- Fair Poor <br /> Purging Equipment 2"disposable bailer X Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer. floTeflon bailer Disposable Tubing <br /> Well Diameter 2" /"-- 4" 6" 8" <br /> Purge % of Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time — 6 : 3 3 Time 2 Calculated purge 3 <br /> Depth of well '7 q Z C) Depth to water y d' rr Actual purge 1 <br /> Depth to water y 'y/ <br /> Start purge Q �- o Sampling time " 3 <br /> Time Temperature EC pH Turbidity Volume <br /> �' = 22 G 2- <br /> Yo <br /> yo 3 <br /> Sample appearance �i►/L� Lock <br /> Equipment replaced (check all that apply) Note condition of replaced items) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />