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tai , <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3-13 _yS^ _ <br /> Site: Beacon 4502 Project No. : 94-502-01 <br /> 35 North Cherokee Lane Well Designation: MW- S <br /> Lodi. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YDS Above TOC Below TOC <br /> Is top of casing cut level? 1__Y <br /> �� If no, see remarks <br /> Is well cap sealed and locked? ES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI X d-1 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good Fai (Poor, <br /> Purging Equipment: 211 bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:_ -�(r Teflon bailer: <br /> Well Diameter: 2" 4" X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: lOoy Time: 13) Calculated purge: ?- <br /> Depth of well: 76 Depth to water: S6.10 Actual purge: r <br /> Depth to water: 56.6 <br /> Start purge:, 1047 Sampling time: 135 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 64. 4 Soo 7,4 �� Z <br /> 63 J 7 y� 3 <br /> 67 <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: 9/15 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />• Remarks: <br /> Signature: _ <br />