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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Inc Sampling Date 6-- <br /> Site <br /> — <br /> Site BeaconfAT __3 6`4 1 Project No 94-641-01 <br /> 1210 E Hammer Lane Well Designation (/w <br /> Stockton, CA , <br /> Is setup of traffic control devices requued9 YES time hours <br /> Is there standing water to the well box? 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 klM If no, see remarks <br /> Height of well casing riser(in inches) --�— 1 G <br /> Well coyer type 8" or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12 ' Christy 8"M&D 12"M&D 12" DWP <br /> 12" CNINI ^� 12"Pomeco Other <br /> General condition of we lhead assembly Excellent GoodFair 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" Ity— 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 6 . / 9 Time Calculated purge <br /> epth of well Depth to water Actual purge <br /> epth to water so <br /> Start purge q: 7 Sampling time 36 <br /> Time Temperature EC pH Turbidity Volume <br /> Gt ze 4 '-�l - -� o 7 - Z � <br /> Z 70 3 706 -7, <br /> q 30 � . C 4s 7 , 3 <br /> 3 70 Gz -© <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 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> liemarks <br /> Signature <br />