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c <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3-0 -1 <br /> • Site: Beacon 9502 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? (9YES Above TOC Below TOC <br /> Is top of casing cut level? NO (_Ytq If no, see remarks <br /> Is well cap sealed and locked? If no, see remarks <br /> Height of well casing riser (in -inches) : <br /> Well cover type: 8" UV 12" UV 1211 EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other VA <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: k 2" 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" X 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time• 0/0 Time: ISI— Calculated purge: 1, k <br /> Depth of well: 6-6-16 Depth to water: S-60 Actual purge: 1 ii <br /> Depth to water: _ �y73 <br /> Start purge: Sampling time: 152 <br /> Time Temp. E.C. pH Turbidity Volume <br /> Ay <br /> it � C7 �� � • ' , <br /> Z§ u <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: ` <br /> Signature: <br />