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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation /V! <br /> Stockton,Ca <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well box9 YES Above TOC Below TOC <br /> Is top of casing cut leveh NO If no,see remarks <br /> Is well cap sealed and locked? rj NO If no,see remarks <br /> Height of N ell casing nser(in triches) - <br /> Well co%er type 8"or 12"L!V 12"EMCO 8"or 12"BK 8"Chnsry <br /> 12"Christy 8"M&D 12"M&D�_ 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good_ Fair Poor <br /> Purging Equipment 2" disposable bailer X, Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled %�ith Disposable bailer :!r Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4"_ X 6" 8" <br /> Purge Vol Multiplier 016 665 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time GTime 9 ' '? o Calculated purge f <br /> • Depth of well r Depth to water < J Actual purge _ _S <br /> Depth to Ntiater 7" <br /> Start purge '9 - ) '6 Sampling time 1 <br /> Time Temperature EC pH Turbidity Volume <br /> oil <br /> Sample appearance �-�c G-tr 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 />