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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 0-- <br /> Site <br /> `—=Site Beacon#== _ I Protect No <br /> Well Designation V W <br /> Is setup of traffic control devices requued9 YES time hours <br /> Is there standing water in the well box's YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked9 +J O NO m <br /> If no,see rearks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8" Christy <br /> 12" Chnsry 8" M&D 12"M&D 12"DWP <br /> 36"CNI 12"Pomeco Other <br /> G&'c 1 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 _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 4"" " Y 8 Time C, 'k 3 I + Calculated purge y <br /> Depth of well 5-S' o 7 Depth to water g' OI Actual purge <br /> Depth to water y6 S <br /> Start purge L' Sampling timeF 3 <br /> Time Temperature EC pH Turbidity Volume <br /> `7- elf L <br /> Gc2,0 <br /> 7l 7 , 16 <br /> Sample 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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWT) <br /> Remarks <br /> Signature <br />