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DOULOS 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- 3 <br /> Lodi, CA <br /> Is setup of traffic control devices required? (g) YES time: hours <br /> Is there standing water in well box? Q0 YES Above TOC Below TOC <br /> Is top of casing cut level? NO 4=P If no, see remarks <br /> Is well cap sealed and locked? ® YES If no, see remarks <br /> Height of well casing riser (in inches) : • Z <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP �k 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 3' 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:-L-- Teflon bailer: <br /> Well Diameter: 2" 410 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />• Time: /ors Time. zo3 Calculated purge: 1� <br /> Depth of well: S$21 Depth to water: S 6.an Actual purge: 6 4 <br /> Depth to water: �7 <br /> Start purge: //JO Sampling time: z07 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1135 7S ) <br /> If 40 63_� �� 53 2 <br /> 1 d 6 <br /> Sample appearance: Lock: �2 <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 />