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DOULOS EWIRONIKENTAY, COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: /- <br /> SSite: Beacon { 695 Project No. : 94-695-01 <br /> 00 S. Cherokee L e Well Designation: KW- 0 <br /> Lodi. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing dater in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO W If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : %t <br /> Well cover type: 8" UV 12 90 UV 12 99 EMCO 8 99 BK <br /> 1211 BK 12 09 DWP 1211 CNI 3611 CNIer <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: >' 2" disposable: bailer Submersible pump <br /> 200 PVC bailer Dedicated bailer <br /> 490 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:—.�(' Teflon bailer: <br /> Well Diameter: 211 4" 6" Sol <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initia4 Meagurement - Rocharge Measurement <br />®Time: "� _ Time: �� � Calculated purge: <br /> Depth of Eae11: Depth to Easter: Actual purge: <br /> Depth to water: 6r <br /> Start ?urge: - / ' Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <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 />