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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date _ 1 `1-� - O j <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation j In w T <br /> Stockton,Ca <br /> Is setup of traffic control devices required YES tune hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut leveh NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well co%er type 8" or 12"LTV 12"EMCO 8"or 12"BK 8"Chnsry <br /> 12"Chrism 8" M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12" Pomeco Other I /✓3 <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer 5L Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer_ Teflon bailer Disposable Tubing <br /> Well Diameter 2" � 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement U <br /> Time (�5_ 20 Time _ �5' : S$ Calculated purge f <br /> Depth of well SS Depth to water /0-" Actual purge <br /> Depth to water � 7 q l j <br /> Start purge 6 ' s F2 Sampling time �� S <br /> Time Tem erature EC H Turbidity Volume <br /> 6: 3 e� , 7 i 7 g `7 S o r <br /> � S 1 t7v 7 '3 � <br /> Q6S `7 • � �' 3 <br /> Sample appearance moi✓ Lock ' <br /> 71 <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 /> Signature <br />