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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar.-Inc- Sampling Date 6 - <br /> Site <br /> -Site _ Beacon f4'1 3 6141 Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation w {` <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water to the well boxy s Above TOC Below TOC <br /> Is top of casing cut lever NO 6aV If no, see remarks <br /> Is well cap sealed and locked7 NO YE If no, see remarks <br /> Height of well casing riser(in itches) <br /> Well co,,er type 8" or 12" W 12"EMCO 8"or 12"BK_,K, 8"Christy <br /> 12 Chrtsry8" M&D 12"M&D 12"DWP <br /> 12"C\I 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goad Farr 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" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 7-65 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time g Time _...7 : 3 _ Calculated purge ( g ' <br /> of well -7 c{ '4Depth to water Actual purge <br /> S'Pepth <br /> epth to water Y ; 2 <br /> Start purge 7 -130 Sampling time 7 = 3 <br /> Time Temperature E C H TurbidityVolume <br /> 7: 3 f 6� - � 12 S � . 2 r <br /> 7 ' ? Z 70 Z/a 7 . 3 g <br /> 7= 33 -70 • S �q / 7 33 <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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks <br /> Signature <br />