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DOULOS MMIRODTMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: la-L 9'G1s <br /> Site: Beacon A695 Project No. : 94-695-01 <br /> JQ0 S. Cherokee )�a U2 Well Designation: <br /> Led i. CA <br /> Is setup of traffic control devices roWircx2? YES time: hours <br /> Is there standing water in well box? � ve TOC Below TOC <br /> Is top of casing cut Ievel? _ ® " remarks <br /> Is well cap sealed and locked? N � _ o cee remarks <br /> Height of well casing riser (in inches) : ' <br /> Well cover type: 8" UV 1211 UV 12 •�� " �"' BK <br /> 1214 BK 1204 DWP 120 CNI 3 6 W CNH_____ <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2°0 disposable bailer Submersible pump <br /> 200 PVC bailer Dedicated bailer <br /> 4D1 PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> well Diameters <br /> ftrq* Vol. Mult4liera 0. 16 O.&S 1.b47 2.61 gag/ft. <br /> foLaw" µ map <br /> i a Calculatod purge: IXf <br /> Depth of wagl o ,Bl Dcpth to water: 6 Actual purgo: 21 vg <br /> es Sling tip: 3 11 <br /> TwW. pH Turbidity Volumo <br /> 3 66 X43 75 2 <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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br /> � ,� <br />