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DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date - 1- 7— Q f <br /> •� Site Beacon #3641 Project No <br /> 1210 E Hammer Lane 1400 Well Designation <br /> Stockton,Ca <br /> Is setup of traffic control devices required9 YES tune hours <br /> Is there standing water un the well box9 YES Above TOC Below TOC <br /> Is top of casing cut level9 NO -tM If no, see remarks <br /> Is well cap sealed and locked9 NO If no, see remarks <br /> Height of well casing riser(in inches) ! <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Chnsty 8"M&D 12"M&D 12"DWP <br /> 12"CNI CNI ,�. 12"Pomeco Other <br /> General condition of el ead assembly Excellent Good Fau Poor <br /> Purging Equipment X 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer. Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time Time q s Calculated purge <br /> Depth of well C�=� f` Depth to water s0 , S� ActuaI purge r <? <br /> Depth to water t/ " <br /> Start purge 3 G Sampling time •S <br /> Time Temperature E C pH Turbidity Volume <br /> `f - Cf <br /> cl <br /> Sample appearance 6: Lock'Qw-- <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 /> Remarks <br /> Signature <br />