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DOULOS ENVIR014MENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6-U'4-q6 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 16 <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 If no, see remarks <br /> Is well cap sealed and locked? NC� E 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" DWP 12" CNI�_ 36" CNI General condition of wellhead assembly: Excellent g�her <br /> Fair Poor <br /> Purging Equipment: V'2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:-1— Teflon bailer: <br /> Well Diameter: 2" f 4'I 6" 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measureme t Rechar a Measurement <br /> Time:— Calculated purger <br /> Time: L35 <br /> �✓ Depth of well: L� _ Depth to water: Actual purge: � � <br /> Depth to water: 63 <br /> Start purge: 2Sampling time: r A LJ _ <br /> Time Temp. E.C. pH Turbidity Volume <br /> 710 71 2 <br /> 7/5 61 f-2 4� <br /> 7 a - 2Ir <br /> di <br /> Sample appearance: � 1 Lock: n <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 />