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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 1-17-15 <br /> • Sao Beacon#695 "act No 94695-01 <br /> 900 South 9muga.L Well Designation MW- <br /> Lodi, <br /> WLodr.CA <br /> Is setup of traffic control devices requued? YES tune hours <br /> Is there standing water in well bolt? YES Above TOC Below TOC <br /> lu top of casing cut level? NO If no,we remarks <br /> Is well cap reales and locked? NO If no,me remarka <br /> Height of eenell casing naer(En nnchea) <br /> Well cover type S"UV 12"UV 12"EMCO S"BK <br /> 12" BK 12" DPW 12"CNI 36"CNI Other <br /> General condition of wellhead assembly Excellent Farr Poor <br /> Purging Equipment r disposable bailer Submersrble pump <br /> 3"PVC baler Dedicated bailerr <br /> V PVC bailer Centrifugal pump <br /> Sampled with Disposable bolpr Teflon bailer <br /> Well diameter 2" _ 4" 6" >1" <br /> Purge VoL Multrphw 016 0 65 147 2.6I ga11R <br /> Tam --/AI or -- - T �� Calculated purer 3 9 <br /> Dapth off wall 7.e to w=r 70,6 (5 Actual purrga <br /> Depth to crater S 9 6o <br /> Stat purge S=Plmg time . <br /> rune Temperature pH Turbidity VAIM <br /> 337 7 / --� <br /> 93 !e lot <br /> 3 41) <br /> Sample appearance 4ZA&�' Lock <br /> Equipamt replwW (Checks all that opply) Note condition of replaced itaw <br /> 2"lockmg cap L.czft 03753 7132 Allenbead <br /> 4"locking cap Lasts-Dolph 9116 bolt <br /> 6" locking cap Pmned Allenhead(DPW) <br /> Remark <br /> Signature fit_ <br />