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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> " Client: Ultramar Sampling Date: a`3_9 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <br /> Lodi CA <br /> Is setup of traffic control devices required? N4 YES time: hours <br /> Is there standing water in well box? YES 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) : b <br /> Well cover type: 8" UV 12" UV 12" EMCO 811 BK <br /> 12" BK 12" DWP 12" CNI 36" CNI they <br /> General condition of wellhead assemb y• Excellent Goa Fair Poor <br /> Purging Equipment: 2" 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"X 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 .47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ILS Time: 750 Calculated purge: <br /> Depth of well: C2, kl Depth to water: Actual purge: <br /> Depth to water:j 6:,66 <br /> Start purge: 6 5 Sampling time: 751 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 65q G 'F 3G:7- 73f 21 <br /> Sample appearance: Lock: -malty, <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> . Remarks: <br /> Signature: r <br />