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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 1 t <br /> Site Beacon # 36 Y I Project No <br /> Well Designation V LJ/ <br /> Is setup of traffic control devices required? rime hours <br /> Is there standing water in the well box? Above TOC Below TOC <br /> Is top of casing cut lever If no, see remarks <br /> Is well cap sealed and locked 1!A If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12"W 12"EMCO 8" or 12"BK 8"Christy <br /> 12" Chnsry 8"M&D 12"M&D 12"DWP <br /> 12" CM36"�I C 12"Poineco Other <br /> General condition of we�tlh ad 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" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time ? y Time 2 7 Calculated purge <br /> Depth of well Depth to water i-/ 7. O Actual purge 3 <br /> Depth to water E/ S'S <br /> Start purge 3 Sampling time - 2 <br /> Time Temperature E C pH Turbidity Volume <br /> loo 1 -7 2 <br /> c7 ri d -7 v <br /> zr u <br /> Sample appearance C�e � Lock <br /> I <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWT) <br /> Remarks <br /> Signature <br />