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-- - _'_e....v. ....,,w..+^.cs. ...� ,...�.. ....-.w.�.+.......,........y.. �. .. .mai+.."'-s <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date C .1 <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton Ca <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water m the well boxy O YES Above TOC Below TOC <br /> Is top of--asing cut level9 NO If no,see remarks <br /> Is well cap sealed and locked? NO 1✓ If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well co%er Type 8" or l2"UV 12" EMCO 8"or 12"BK 8"Chnsty <br /> 12"Chnsty 8" M&D 12"M&D12"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 ,�P 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 Rechar e Measurement �� <br /> Time G 3, Time 1 Q Calculated purge <br /> Depth of well 7,4 e� c5) Depth to water Actual purge e � <br /> Depth to «ater y 4� • S 7 <br /> Start purge —7 = S Sampling time 9 - <br /> Time Tem erature E C pH Turbidity Volume <br /> -7 = SZ 7 116Q • °18 <br /> ' Q y 6s <br /> Sample appearance ���� 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 /> Remarks <br /> Signature <br />