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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Ultramar Saimplmg Date <br /> Site Beacon#695 Project No 94-695-0 <br /> 900%Lujh Cherokee Lane Well Designation MW-30 <br /> Lodi.CA <br /> Is setup of traffic control devices required? YES tune howl <br /> In there atandmg water in well box? YES Above TOC Below TOC <br /> To top of casmg art level? NO ipIf no,we remarlm <br /> Is well cap wAdW and locked? NO 10If no,we remarks <br /> Height of well casing riser(m inches) � <br /> Well cum 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 Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 3" PVC bader Dedw4ted bailer <br /> 4" PVC bailer --Centrifugal pump <br /> Sampled with Disposable bailer Teflon baler <br /> Well diameter 2" 4" 6" >1" <br /> Purge Vol MulbpUer 016 065 147 261 gaVfL <br /> Initial Meastut <br /> Tuna m"" Tune aQ Calculated purer 1 <br /> Depth of well 6111 Depth to watur�_ Actual purge �! <br /> Depth to water <br /> wi i H <br /> Start Purge — Samplmg t m° <br /> Tune Temperawe EC pH 7urbrdtty Volume <br /> zi Z6 jU 236 1 <br /> 7/,S, .I. Y <br /> Sample appeueooeCA0.21 Lock <br /> Equipment replaced (Chemo all that apply) Note condition of replaced rkmw <br /> 2"locking crap Leafs 03753 7132 Aiknhea <br /> 4"lecking cap Lceh-Dolphm 9116 bolt. <br /> 6"lacking cap Pinned Allenhead(DPW) <br /> Remartm <br /> 01 <br /> Signature r' <br />