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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #695 Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: --1 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> is well cap sealed and locked? ASO ES If no, see remarks <br /> Height of well casing riser (in inches) : ] <br /> Well cover type: 811 1211 UV1211 EMCO 8 1° BK <br /> 1211 BK 121° DWP. 1211 CNI 3611 CNI - ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: _ Teflon bailer: <br /> Well Diameter: 2114 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechg1rae Measurement <br /> Time: all _ Time; r' Calculated purge: a.� <br /> Depth of well: 6 Depth to water: RS Q 9 Actual purge: .,f <br /> Depth to water: 6�L <br /> Start purge: Jr�- Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7.2o j <br /> 6 �j� <br /> Sample appearance: Lock: i <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: ' `' <br />