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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No <br /> I210 E Hammer Lane 1400 Well Designation /,I <br /> w 3 <br /> Stockton,Ca <br /> Is setup of traffic control devices requireV YES time hours <br /> Is there sanding water in the well box'sO YES Above TOC Below TOC <br /> Is top of casing cut levels O elmp If no, see remarks <br /> Is well cap sealed and locked? L NO If no, see remarks <br /> Height of«ell casing nser(in inches) `� 1 o <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> - <br /> 12"Chnsry 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco= Other <br /> General condition of wellhead assembly Excellent GoodFair Poor <br /> Purging Equipment 2" disposable bailer X Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled r,4 ith Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 6 2 Time d17 - 9 <br /> _ `7 : Calculated purge <br /> Depth of well `7 y l_/ 3 Depth to water _._ 'L� /� Actual purge ( 7 <br /> Depth to water <br /> Start purge -7' 2 Sampling time -7 ' 3 <br /> Time Temperature E C pH Turbidity Volume <br /> -7 : 2s G .,� • r 7 - 36 r <br /> -7 �0 `? • !o <br /> 7 . 2 7 G6 6 0 1 t'2 <br /> 7 29 6G L q `I <br /> Simple appearance (�p_ �� 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 /> S ignature <br />