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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date r ' <br /> Site Beacon 19ft 3 6 Project No <br /> Well Designation Jc <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well boxy QRD YES Above TOC Below TOC <br /> is top of casing cut lever NO If no, see remarks <br /> Is well cap sealed and locked' r O NO If no, see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8" or 12"UV 12" EMCO 8"or 12"BK 8"Chnsry <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> 12"CNI .3 1 �— 12" Pomeco Other <br /> General conditionof ww iad assembly Excellent Good Farr 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" X 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Irutial Measurement Recharge Measurement <br /> Time / ' ; 7 Time 't ' / C7 Calculated purge <br /> Depth of well � S y Depth to water 7 /6 Actual purge j 2 <br /> Depth to water •/ <br /> Start purge 4 Sampling time - C <br /> Time 1 Temperature EC 2H Turbidity Volume <br /> x : 06 er � � Il <br /> = C) '� 3 r7 / oS'd -7 , <br /> X001 < -2- <br /> Sample <br /> Sample appearance �W�/L Lock <br /> Equipment replaced (check all that apply) Note condition of replaced itern(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 />