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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Sampling Date: 6-..2-Y-16 <br /> Client: Ultramar p g <br /> • <br /> Site: Beacon #695 Project NO. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: RW- <br /> '1 <br /> Lodi CA <br /> Is setup of traffic control devices required? Q YES ES time.TOC Below TOC <br /> hours <br /> Is there standing water in well box. <br /> Is top of casing cut level? NO If no, see remarks <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" U 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellen ao Fa1r 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: 2" 4" 6"4 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: I-L4 _ Time: -4 .1 S Calculated purge: . <br /> Depth of well:_rl ` Depth to water:_C C,-fe Q Actual purge: rl W 1� <br /> Depth to water: '/ <br /> Start purge: 2.4,;t Sampling time: 1+ <br /> Time Temp. E.C. pH Turbidity Volume <br /> 251 . s /3 i?# 1 <br /> 303 71 Ll /05 73 2, <br /> 7a1. 7.z 3 <br /> 31 74:1 131 is � <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 />