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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Ultramar Sampling Date 9"1 7-95 _-- <br /> Site Beacon#695 Project No _ 94-695-01 <br /> 900 South Cherokee Lane Well Designation. RW- ol, <br /> _ . Lodi-C& <br /> Is setup of traffic control devices required? O YES tune hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> In top of casing cut level? NO If no,we remar1w <br /> Is well cap sealed and locoed? NO If no,coe retmarka <br /> Height of well casing noir(n incheo) I Q-- <br /> Well cover type $"UV 12'UV 12"EMCO r BK <br /> 12" BK 12" DPW 12"CNI 36"CNI Ome <br /> General condition of wellhead assembly Excellent �(Good) Fair Poor <br /> Purging Equipment. 2"dMmable bailor Submersible pump <br /> 3"PVC bailer Dedicated ballet <br /> 4"PVC bailer _Centrtfupl pump <br /> Sampled with Disposable bailer Teflon bailer <br /> Well diameter 2" 4" 6" O" <br /> Purge Vol. Multiplier 016 065 147 2 61 gaUR <br /> Inn"moasummeatRAW=M!"AtmMCM! <br /> Tom _ r=2 ;1 D Calculated pu 3a <br /> Depth of well 19 Lj Dptb to grater i; `1 5-3 Actual pu^( <br /> DL-pth to viater 1J9,�2Z= <br /> Start purge 2-1do Sampling tame32-1 _ <br /> Tune Temperature E C pH Turbtdrty Volume <br /> Z- AA1 Ll <br /> Sample appearanoo � Lock <br /> Eqwpment reply (Check all that apply) Note condition of replaced item <br /> 2" locoing cap Lass 03733 7132 Allem <br /> 4" locking cap Lash-Qa}pb►tn 9116 bolt. <br /> 6" locking cap Punned Allen"(DM <br /> Remarhn <br /> Signature <br />