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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar. Inc Sampling Date <br /> • Site Beacon 3�"y I Project No 94-64I-01 <br /> 1210 E Hammer Lane Well Designation 110 u' <br /> Stockton, CA <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water m the weil boxy YES Above TOC Below TQC <br /> Is top of casing cut leve? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Vl ell cover type 8" or 12" W 12"EMCO 8"or 12"BK 8"Christy <br /> 12 'Chrisry8"M&D 12"M&D 12"DWP <br /> 12 Clv1 36" CNI 12"Pomeco Other I <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" gt/ <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 5' 3 Time _ 45 " y Y Calculated purge <br /> Wepth of well Depth to water 1/ 7 /�5 Actual purge S s <br /> epth to water <br /> Start purge b - G Sampling time 6 YS— <br /> Time <br /> STime Tem erature E C pH Turbidity Volume <br /> 37 cl 7 -50 <br /> ?l -20 - 9 el 7 . 36 3 <br /> yD / - o � 3S <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 /> �emarks <br /> Signature <br />