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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> CIient Ultramar. Inc Sampling Date <br /> Site Beaconbe 1 Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation LV <br /> Stockton CA <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well boxy YES Above TQC Below TOC <br /> Is top of casing cut level9 NO K=> If no, see remarks <br /> Is well cap sealed and locked9 NO <y0D 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"Chrisry 8"M&D 12"M&D 12"DWP <br /> 12"CNI 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 bailerTCentnfugal pump <br /> Sampled with Disposable bailer ><- Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gallft <br /> Initial Measurement Recharize Measurement <br /> TimeS' ! , Time `7 = 2— Calculated purge <br /> Wepth of well �- T Depth to water VS qQ Actual purge 6 �! <br /> epth to water L( z <br /> Start purge Sampling time 7 <br /> Time Temperature EC 12H Turbidity Volume <br /> 7 ' Y S 651 3 // 0 ! 3 <br /> � 6 � o l/� D -7 , 2 <br /> 7 ' 4 2e log - 06 <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 />