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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: ' <br /> Site: Beacon 695 Project No. : 94-695-01 <br /> 900 S. 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? NO fEb If no, see remarks <br /> Is well cap sealed and locked? NO V08 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNIt _ 36" CNI Other <br /> General condition of wellhead assembly: Excellent Go Fair Poor <br /> Purging Equipment: �\-/ 21f disposable bailer Submersible pump <br /> 2 PVC bailer <br /> ler <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 699 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharcte Measurement <br /> Time: Time: 9-- Calculated purge: O 7 <br /> Depth of well: 67 Depth to water:. F�7 o 2 Actual purge: <br /> Depth to water: 6 _ <br /> Start purge: 731 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 744 5 <br /> Lir- <br /> Sample appearance: 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 /> J <br /> signature: <br />