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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFOR1ATION 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 If no, see remarks <br /> Is well cap sealed and locked? i ! If no, see remarks <br /> Height of well casing riser (in inches) : d— <br /> Well cover type: 8" Uv 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI V 36" CNI her <br /> General condition of wellhead assembly: Excellent o 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:_„ Teflon bailer: <br /> Well Diameter: 2" 4 4" 6" 8'I <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement od <br /> Time: /1.�- Time: X11. Calculated purge: /. 7 <br /> Depth of well: ce3a Depth to water: 6 6.] Actual purge: /a <br /> Depth to water: g *!r_&/ <br /> Start purge: J-0 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 11, 'i �- <br /> 4` .1 /00J_ <br /> 43 -1 J <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: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />