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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date <br /> Site Beacon #3641 Protect No <br /> 1210 E Hammer Lane 1400 Well Designation /1 W <br /> Stockton,Ca__ <br /> Is setup of traffic control devices required O - YES time hours <br /> Is there standing water in the well boxy _O YES Above TOC Below TOC <br /> Is top of casing cut levels NO If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(m inches) 2 <br /> Well coy er type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy 8"M&D 12"M&D 12" DWP <br /> 12"CNIfir--"' 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good_ Fair 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 1 P Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" X,, � 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time Time -- 9 cn o Calculated purge �r" ` 3 <br /> Depth of well = r Depth to water j `` Actual purge f`fl <br /> Depth to water r <br /> Start purge Sampling time <br /> Time J Temperature E C H Turbidity Volume <br /> og ^ <br /> _ � l <br /> toy > > <br /> rLl ; <br /> Sample appearances - 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 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> �emarks <br /> Signature <br />