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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Clients Ultramer Sasnplmg Date <br /> Site Beacon#695 Project No 94-695-01 <br /> �2N 3ouffi Cherokee Lane __ Well Desegnateoa. MW- <br /> Lodi.CA <br /> Is setup of traffic control de-view required? YES time hours <br /> Is there standing water in well box? Y�E^S� Above TOC Below TOC <br /> Ia top of casing cut level? NO If no,we remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well caaing user(in enchea) <br /> Well cover type 8"UV 12"UV 12"EMCO S"BK <br /> 12"BK 12"DPW _ 12"CM 36"CNI Outer <br /> General condition of wellhead assembly Excellent Fair Poor <br /> Purging Equipment: 2"disposable bider Submersible pump <br /> 3"PVC bailer Dedicated bOa <br /> 4"PVC bailer CenWfiq )pump <br /> Sampled with Disposable bailer _ Teflon bailer <br /> Well diameter 2" _ 4" 6p S" <br /> Purge Vol Multiplier 016 063 147 261 SAM <br /> Initial Me &RbArg MeAg=M <br /> Tune ,/1/it Tum I 6tj � Calculated purr <br /> Depth of well 6 q, Daptb to MW Actual pts t_9 9 <br /> Depth to water <br /> Start purge Sampling tune /A <br /> Terre Temparaturo E. C pH Turbedrty Voltme <br /> 116 114ZV <br /> 720 laz 715 <br /> Sample appearance: Lock dideA <br /> Equipment replaced. (Clic all that apply) Note caedegaa o1'r+eplaoed etmw <br /> 2" locking cap Lias 03733 7132 ADenheal <br /> 4" locking cap Lodi-Dolphin 9116 bolt <br /> 6" locking cap Punned Allenhecd(DM <br /> Remarlca <br /> Signature <br />