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DOULOS RNVIRONMSNR'AL COMPANY SAMPLING INFORMATION SHEET <br /> Client:- Ultramar_ Sampling Date: f-l',4 35 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S eChargkoe Lane Tell Designation: RW�a _ <br /> Lodi. CA <br /> is astup of traffic cQAUml devAces required? -,(]IS -tipes�,�. boors <br /> ffs t$ t'e-�ttax &i water i 1 . r <br /> el.o�r TOC <br /> iis tQP opt CUt � '_m rem8sk sis we`il cap selaledani? Iocked? remarks <br /> Height of well casing riser (in inches) : '�'" <br /> Well cow types go 12 ' UV 1 ' <br /> 12D BK 12" DWP 12co CNI 360 CNI` <br /> General conditio f wellhead assembly: Excell i Fair Poor <br /> Purging Equipments 2w disposable bailer Submersible pump <br /> 20 PVC bailer Dedicated bailer <br /> 40 PVC bailer __Z_Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> wall, µ -�io <br /> TIT <br /> Purgw- <br /> 77 <br /> - <br /> '�� <br /> *Depth <br /> J O - <br /> r/ qs +` <br /> - <br /> _ s-3 <br /> �0 6 6 r, yz <br /> 7/ 7 6f5 /,�az -?d7 3 <br /> 9�s 679 <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 />