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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Ditto <br /> . Site Beacon#695 Project No 94-695-01 <br /> 900 South Cherokee' an Well Designation MW- Z-1 <br /> d Lodi.CA <br /> In setup of traffic control devices required? ® YES time hours <br /> In there standing water m well bolt? JR? YES Above TOC Below TOC <br /> In top of casmg cut level? NO E If no,we remarks <br /> Is well cap sealed and looked? NO If no,we remarU <br /> Height of well casing neer(in mchen) _ "k �- <br /> Well cover type 8"UV 12"UV 12"EMCO 8"BK <br /> 12"BK 12"DPW�_ 11"CNI 36"CNI Other <br /> General condition of wellhead assembly Excellent cod Fair Poor <br /> Purging Equipment. 2"disposable bail Submersible pump <br /> 3"PVC basler Dedicated bailer <br /> 4"PVC bailer _ _Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer <br /> Well diameter 2"_� 4" 64 8" <br /> Purge Vol. Multiplier 016 065 147 261 PM <br /> nttial charge Measument <br /> iTime Ttrtr.3 aj Calculated purtp - aa'ed <br /> Depth of well -6 E J.-6 Dzptb to rmtw -C _ Actual pure per?n ,, <br /> Depth to water Aj52jZ <br /> Start purge 11 Sampling time_ <br /> Trane Temperstum E-C pH Turbidity Vohim <br /> Ica It <br /> Sample appearance Lock <br /> Equipment replaced (Check all that apply) Note condition of nTlaosd items <br /> 2" locking aep Lads 03753 7/32 Allenhead <br /> 4" lorkmg cap Lath-Dam 9/16 bolt <br /> 6" lockmg cep Pinned Allenhwd(DPW) <br /> Remarks <br /> Signature <br />