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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client _ Ultramar, Inc _ Sampling Date G `� <br /> . Site Beacon j541 3 by _ 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 boxyN YES Above TOC Below TOC <br /> Is top of casing cut level'? NO If no,see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser(in inches) 19 <br /> ell cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12 Christy8' M&D 12"M&D12"DWP <br /> 12" CNN 36"CNI 12" Pomeco 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 Centrifugal pump <br /> Sampled with Disposable bailer -� Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time _�,5� T_ Time '? 7 Calculated purge D d <br /> Wepth of well ] Depth to water 7 9.5 Actual purge 7 O O <br /> epth to water _ S 6"5- <br /> Start <br /> "SStart purge 9 ' 0,1_ Sampling time .. '9- ( 9 . <br /> Time Temperature E C 2H Turbidity Volume <br /> g : os � 8 ( 3 � c� .or <br /> . og <br /> 11 G La Ito I G -7Z 3 <br /> Sample appearance � �.,�� Lock tz-1- <br /> Equipment replaced (check all that apply) Note condition of repl ed 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 (DWP) <br /> �emarks <br /> Signature <br />