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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 2 <br /> Site Beacon ##3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation 4n W <br /> Stockton Ca <br /> Is setup of t,affic control devices required9 6aP YES tame hours <br /> Is there starding water in the well box9 Q YES Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked') NO ES If no,see remarks <br /> Height of �ell casing riser(an inches) 1 0 <br /> Well co.er rype 8"or l2"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12" Christy 8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Porneco_ X Other <br /> General condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer X Centrifugal pump <br /> Sampled �%ith Disposable bailer I/, Teflon bailer Disposable Tubing <br /> Well Diameter 2" / 4" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time / Time 7 ' y Calculated purge J <br /> . Depth of well _ - L� 2 Depth to water 5 �O Actual purge ( s <br /> Depth to w ater ' <br /> Start purge -7 Q Sampling time -7 S� <br /> Time Temperature E C 2H Turbidity Volume <br /> 7 : u f 67 loo 7 � 0 <br /> 'L �I `7 y L <br /> 966 <br /> Sample appearance r�G - 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 9116 Bolt <br /> 6" Locking Cap Pinned AIlenhead (DWP) <br /> .Remarks <br /> Signature <br />