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DOULOs ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: — 9 <br /> Site: Beacon #695 Project No. : 94-695-011 <br /> 900 S. Cherokee Lane Well Designation: MW- �_ O <br /> Lodi , CA <br /> Is setup of traffic control devices required? 50 YES time: hours <br /> Is there standing water in well box? (�gP YgS, Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 12" EMCO 8f, BK <br /> 12" BK 12" DWP 12" CNIX 36" CNI her <br /> General condition of wellhead assembly: Excellent eoo Fair Poor <br /> 3 HEEL <br /> Purging Equipment: X2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:- Teflon bailer: <br /> Well Diameter: 2" 411-/, 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 10 -40Time: Calculated purge: - <br /> Depth of well. i Depth to water: Actual purge:_! b1 9�..� <br /> Depth to water:—!L 11 <br /> Start purge: 1 , 03 Sampling time: 5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> o 9- 5 9 7. 27 ---- a <br /> 1 - J6 79 1/ `] 91 7.G3al 7 <br /> � <br /> o g y <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 41' Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> r J <br /> Signature: <br />