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rDOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br />• Site: Beacon #502 Project No. : 94-502-01 <br /> 35 North Cherokee Lane Well Designation: MW- -� <br /> Lodi. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of 'casing cut level? O } If no, see remarks <br /> Is well cap sealed and locked? N YES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12"' UV 12" EMCO 8" BK <br /> 12" BK 12" DWPgkf' _ 12" CNI 36" CNI Other . <br /> General condition of wellhead assembly: Excellent Good Poor <br /> 3 X� <br /> Purging Equipment: ��� f,disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> • Time: IboS Time: 1 L46 Calculated purge: 8' <br /> Depth of well: 19.10 ._ Depth to water. Z Actual purge: 5•� � <br /> Depth to water: ES ER <br /> Start purge: // 07 Sampling time: 1 Lf'S <br /> Time Temp. E.C. pH Turbidity Volume <br /> C 13 <br /> 66? 7 Lt �-- Z <br /> Sample appearance: tP Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks: <br /> Signature: <br />