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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CItent Ultramar Sampling Date 1 'Z-- 13 " D 1 <br /> Site Beacon #3641 Project No -r� <br /> 1210 E Hammer Lane 1400 Well Designation / 1 W - 7 I <br /> Stockton,Ca <br /> Is setup of traffic control devices requrred9 A15> YES time hours <br /> Is there standing water to the well box9 `AO YES Above TOC Below TOC <br /> Is top of casing cut lever NO If no,see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of a ell casing riser(in inches) <br /> Well co%er type 8"or 12"W 12" EMCO 8"or 12"BK 8" Christy <br /> 12" ChnSty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other 1 2- 3M j <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer X_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 811 <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Nleasurement Recharge Measurement <br /> Time = za Time = Calculated purge y <br /> Depth of well V L/ Depth to water `1 �f U Actual purge <br /> Depth to water 7 2 j <br /> Start purge -? _' 3 5 Sampling time <br /> Time Temperature E C 2H Turbidity Volume <br /> 3 6 <br /> 7 -2 3 11 � 0 <br /> 7 - . 06' <br /> -7 3 V 1 (0 ) <br /> Sample appearance G-t, Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> S ignatut e <br />