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i <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: .2-y-916 <br /> Site: Beacon #695 Pr03ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation:_ MW-11 <br /> Lodi CA <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NOS If no, see remarks <br /> Is s well ca sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : r <br /> 811 BK <br /> Well cover type: 811 UV1211 UV1211 EMCO <br /> 1211 BK 1211 DWP 1211 CNIY3 611 CNI the�Tair� <br /> General condition of wellhead assembly: ExcellenGoo tPoor <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: 211 4 11 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement Calculated purge• zG6 <br /> Time: /I/ — <br /> Time: 5 . <br /> SZ 4 <br /> Depth of well: 6 Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge:—zi o Sampling time: ii <br /> Time Temp. E.C. pH Turbidity Volume <br /> 337 73. 4 <br /> 3 q6 3 <br /> 3 145 J]p,5 <br /> Sample appearance: <br /> Lock: 1IaAA, <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 /> ;LA0 <br /> Signature. - - <br />