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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Inc Sampling Date _ 6 / -0 l <br /> • Site _ Beacon 64T 3b`-1 L Project No 94-641-01 <br /> 1210 E Hamner Lane Well Designation V W <br /> Stockton, CA <br /> Is setup of traffic control devices required? YES time __.. .hours <br /> Is there standing water m the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO <j!n) If no, see remarks <br /> Is well cap sealed and locked? O NO CEP If no,see remarks <br /> Height of well casing riser(in inches) <br /> «ell cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12 Christy 8" M&D 12"M&D 12"DWP <br /> 12" C'S'I 1 ?L, 12"Pomeco Other <br /> General condition of wet1he�ad assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" _ 4" 6" g, <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> initial Measurement Recharge Measurement <br /> Time G; '/ Time : Z 2 Calculated purge <br /> Depth of well _ -1 • S �{ Depth to water l0 Actual purge _`� e <br /> Depth to water <br /> Start purge 5 Sampling time 2 3 <br /> Time Temperature E C pH Turbidity Volume <br /> I. ( 4� - 3 /// L7- 2 �* <br /> r6 '7® • �, t / 6 720 <br /> Sample appearance Lock fiaZA4-�� <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 (DWP) <br /> �emarks <br /> Signature <br />