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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> I210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required YES time hours <br /> Is there st.inding water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level) NO If no,see remarks <br /> Is well ca,) sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) 3 <br /> Well co,,er We 8" or 12" UV 12" EMCO 8"or I2"BK 8"Christy <br /> 12"Christy 8"M&D 12"M&D 12"DWP <br /> 12"C I 36" CNI 12"Pomeco Other IT-7-M <br /> General condition of wellhead assembly Excellent Good `C 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 e-p <br /> - Teflon bailer Disposable Tubing <br /> — --- <br /> Well Diameter 2" \ 4" 6" g" <br /> Purge Vol Multiplier 0 6 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 6 ` 2 4 Time —7 - 20 Calculated purge <br /> Depth of %G ell Ss 0 Depth to water LIK ? DActual purge _ <br /> Depth to water _ 1/ S� Z S <br /> Start purge -7 1 1 6 Sampling time 7 2 <br /> Time Temperature E C pH Turbidity Volume <br /> � 16 �s 2 • � � � , 3 I I <br /> S mple 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 />