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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> C1lLnt Ultramar Sampling Date <br /> Site Beacon#3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation 7 <br /> Stockton,Ca <br /> Is setup of traffic control devices required'7 RE YES time hours <br /> ^ ` <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 �E If no,see remarks <br /> Height of well casing nser(m orches) <br /> Well coy er r.,pe 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other f Z S M <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 �X Centrifugal pump <br /> Sampled N%nth Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2"_� 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time , 15- Time e , l ( Calculated purge S <br /> •Depth of well J y YO Depth to water -20 Actual purge <br /> Depth to N%ater T E 4 r <br /> Start purge $ 1-` / Sampling time } �— <br /> Time Temperature E C pH Turbidity Volume <br /> Z- <br /> DS y <br /> Sample appearance 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 Allenhead (DWP) <br /> �emarks <br /> Signature <br />