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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 2 - � 7' j <br /> Site Beacon #3641 Project No c� <br /> 1210 E Hammer Lane 1400 Well Designation V-1 'cl <br /> Stockton,Ca <br /> Is setup of traffic control devices requtred9 YES time hours <br /> Is there standing water in the weII box? YES Above TOC Below TOC <br /> Is top of casing cut leve19 NO Cit!bIf no,see remarks <br /> Is well cap sealed and locked9 NO E If no,see remarks <br /> Height of,�.zll casing riser(in inches) +f 0 <br /> Well co%er type 8"or 12"L V 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco _ Other <br /> General condition of wellhead assembly Excellent Good Fatr 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 t Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" V <br /> Purge \'ol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time � S Time 7 - -7 Calculated purge y 9 <br /> Depth of Nvell -71 QD Depth to water Actual purge _ 1�_ <br /> Depth to water Lf `f _"-a <br /> Start purge 7 - 10 Sampling time '7 <br /> Time Temperature E C pH Turbidity Volume <br /> 10 <br /> Sample appearanceU✓t, Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> ?" Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />