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--�.......�.....wso.,,..�..e ....« ...>`....-. -_....,.,ow..,.K,.rm�r•.�tnara,7er��wrw�---- <br /> DOLLOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date I <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation w <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 level's NO � If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of«ell casing riser(tn inches) _ -"— 'i <br /> Well coyer type 8" or 12"L V 12" EMCO 8"or 12"BK 8" Christy <br /> 12"Chrtsry 8"M&D 12"M&D 12"DWP <br /> TI _ 36" CNI 12"Pomeco Other <br /> Gate 1 condition ofwellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2" disposable bailer T 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" $" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time G ' 3 9 Time Calculated purge <br /> Depth of well O Depth to water ' gActual purge q <br /> Depth to water L/ q <br /> Start purge Sampling time d 5 5 <br /> Time Temperature E C 2H Turbidity Volume <br /> � = 3 6 G - � I <br /> Sample appearance — LockEquipment replaced 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 />