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DOULOs ENVIRONMENTAY, COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6 a4_qz'r <br /> . Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- AQ <br /> Lodi . CA <br /> Is setup of traffic control devices required? N Y S time: urs <br /> Is there standing water in well box? Above TOC el w <br /> Is top of casing cut level? NO If no, see ks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8"' 12" W 12'e EMCO 811 BK <br /> 12" BK 12" DW' V 12" CNI 36" LCNI ther <br /> General condition of wellhead assembly: Excent Goo Fair Poor <br /> Purging Equipment: ��.2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: <br /> Teflon bailer: <br /> / <br /> Well Diameter: 2"_�L 411 611 801 <br /> Purge Vol. multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement <br /> Recharge Measurement 6 <br /> Time: �I1- _ Time: Calculated purge: <br /> Depth of well: 6q 73 Depth to water: G 70 Actual purge: / <br /> Depth to water: 67- _ <br /> Start purge: 4--00 Sampling time: 1-3Z <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1b/ G.r <br /> 74J- <br /> _)L-0j- _24011y <br /> 75Z - 3 <br /> Sample appearance: <br /> Lock: .4-�� <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: Panned Allenhead (DWP) : <br /> Remarks: <br /> Signature: AW <br />