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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Inc Sampling Date _Iq_o l <br /> • Site Beacon-641 36y f Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation M w <br /> Stockton CA <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well boxy S Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is cell cap sealed and locked NO If no, see remarks <br /> Height of well casing riser(in inches) �� <br /> %k ell cc%er type 8" or 12" UV 12"EMCO 8"or 12" BK 8" Chnsty <br /> 12 Christy8"M&D 12"M&D 12"DWP <br /> 12 'CNI 36" CNI 12"Pomecoo_ Other <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 Centnfugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" X 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time <br /> 5- . d Time � : p Calculated purge 7 <br /> eDepth of well 6 Depth to water Actual purge 7 <br /> Depth to water TS <br /> Start purge _ 6 So Sampling time 7 : O t' <br /> Time Temperature EC pH Turbidity Volume <br /> 77 <br /> C . O el <br /> Sample appearance Lock <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 (DAT) <br /> �emarks <br /> Signature <br />