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DODLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:—L-L <br /> Site• Beacon 695 Project No. : 94-695-01 <br /> Rw <br /> 900 S. Cherokee Lane Well Designation: - <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time:,__ <br /> hours <br /> N <br /> Is there standing water in well box' YES Above TOC Below TOC <br /> Is top of casing cut level? NO JZD If no, see remarks <br /> jo If no, see remarks <br /> Is well cap sealed and locked? NO <br /> Height of well casing riser (in inches) :" U 12 6 MCO $" BK <br /> Well cover type: 8" UV12V <br /> 12" BK 12" DWP 12" CNI 36 CNI- y Other, <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled : bailer: <br /> ed with: Dis osal bailerTeflon � <br /> Well Diameter: 2" 4er 6" $n <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> • Initial Measurement Recharge Measurement C/ <br /> Time: 03 <br /> Time: -6 Calculated purge: <br /> Actual purge: 6 3. ?i <br /> Depth of well: �� Depth to water:,. . <br /> Depth to water: <br /> Start purge: 405 Sampling time: L <br /> Time Temp. E.C. pH Turbidity Volume <br /> r oq 71 !K)-- <br /> 1413 <br /> 6)c4r3 �6. 13 0 4� <br /> � <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Ca Lock #3753 :�� 7/32 Allenhead: <br /> �� g p: Lock-Dolphin:— 9/16 Bolt: <br /> 4 Lacking Cap: <br /> 6" Locking Cap: _ Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />