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DOULOS MMIRONMEIMAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: z'2-9-95 <br /> . Site: Beacon #§9§ Project No. : 94-695-01 <br /> - 900 S. ,Cherokee Lane Well Designation: NW-d-) <br /> Lodi. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing mater in well box? Y 0S Above TOC Below TOC <br /> Is top of casing cut level? NO tyd If no, see remarks <br /> Is well cap sealed and locked? NO fy If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 VV 1291 UV 12" EMCO 8 04 BSC <br /> 12 It BK 1240 DWP X 12" CNI 3690 CNI er <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: x„_24° disposable bailer Submersible pump <br /> 240 PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled Faith: Disposal bailer:r44,, Teflon bailer: <br /> Well Diameter: 214 _ 4411 600 g 00 <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ELD Time: !L-5Calculated purge: <br /> Depth of well: 5 ,' Depth to water:]_S. t2_ Actual purge: , <br /> Depth to water: 65, E 6 _ <br /> Start purge: 1_U Sampling time; /1- 54 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7Y <br /> Sample appearance: _ - Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> r� Remarks: <br /> Signature: <br />