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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 S~ <br /> Stockton Ca <br /> Is setup of traffic control devices required9 � YES time hours <br /> Is there standing water u2 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 locked? NO YE If no, see remarks <br /> Height of well casing riser(in inches) t/ 0 __ <br /> Well co,.er type 8"or 12"W 12"EMCO 8"or 12" BK 8"Christy <br /> 12"Christy8"M&D 12"M&D 12"DWP <br /> 12"CNI Y" 12"Pomeco Other <br /> General condition of el ead 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 ,,vith Disposable bailer X Teflon bailer Disposable Tubing <br /> Well Diameter 2" X` 4" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement G <br /> Time ( Time "5f Calculated purge <br /> •Depth of well } O 3 Depth to water o j Q Actual purge <br /> Depth to water <br /> Start purge D Sampling time 43 - l 3 <br /> Time Temperature E C 2H Turbidity Volume <br /> 19 O 7 l 7 �� S <br /> a <br /> �r . o� CS I Io � v -7 <br /> 0cl <br /> Sample appearance C C- ��v 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 />