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DOULOS ENVIRONMEN'T'AL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6 "c-Li-96 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: - <br /> 30 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 0 YES Above TOC Below TOC <br /> Is top of casing cut level? NO tkR If no, see remarks <br /> Is well cap sealed and locked? NO iZ 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 4 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 211 4" 6" $" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement 2 7j <br /> Time: /i0' Time• T Calculated purge: <br /> Depth of well: 7 7 JI _ Depth to water: Actual purge: <br /> Depth to water:-- t; <br /> Start purge: 356 Sampling time: ,5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> q el <br /> 41 <br /> 43 .1 �D �a� 69� Ll <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:, 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> ® Remarks: <br /> Signature: <br />