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DIOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane 1400 Well Designation Al W — <br /> Stockton Ca <br /> Is setup of traffic control devices required9 OSP YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked9 NO YE If no,see remarks <br /> Height of well casing riser(in inches) fi l <br /> Well 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"CNN 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goad_ Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> i <br /> 4" PVC bailer __Centrifugal pump <br /> Sampled with Disposable hailer__LX _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" X 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge_Measu_rement <br /> Time / r Tame 01 ? Q Calculated purge LP <br /> Depth of well Depth to water S I ej Q Actual purge <br /> Depth to water `2 <br /> Start purge Gl �-0 Sampling time <br /> Time Tem erature EC pH Turbidity Volume <br /> 36 ? <br /> Sample appearance Lock r-- <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 />