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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon 43641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation M w r <br /> Stockton Ca <br /> Is setup of traffic control devices requtreV YES time hours <br /> Is there st-,nding water in the well boxy QRYES Above TOC Below TOC <br /> Is top of c.asuig cut lever NO If no, see remarks <br /> Is well cap sealed and locked? NO Xl If no, see remarks <br /> Height of well casing riser(in inches) ) 0 <br /> Well co%er type 8" or 12"LTV 12"EMCO 8"or 12"BK 8" Chnsty <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12" Pomeco_y 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 Centnfugal pump <br /> Sampled with Disposable bailer_J-1P Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge %,ol Multiplier 0 16 065 1 47 2 61 gallft <br /> Initial Nleasurement Recharge Measurement <br /> Time G " 2 2 Time `7 _ / Calculated purge 9 <br /> Depth oC%vell --7 I Depth to water 6 c70 Actual purge S <br /> Depth to water S $ <br /> Siart purge - 06' Sampling time ' <br /> Time Tem erature E C pH Turbidity Volume <br /> —:7-' 0 <br /> o 2 <br /> I <br /> �G 3 7 :7-0 <br /> Simple appearance wt� _Y Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) — <br /> iRemarks <br /> Signature <br />