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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 7 _ <br /> Site: Beacon #695- Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation:_ MW-_ ~ _ <br /> Lodi, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? `No YES Above TOC Below TOC <br /> Is top of casing cut level? NO YES If no, see remarks <br /> Is well cap sealed and locked? NO YES: If no, see remarks <br /> Height of well casing riser (in inches) : _1/ <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI ' 36" CNX Other <br /> General condition of wellhead assembly: Excellent 000d 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" 4" 611 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 .47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />• <br /> Time: ; 7 Time: 'N: � Calculated purge: <br /> Depth of well: Depth to water: f Actual purge: <br /> Depth to water: <br /> Start purge:. 5-L-r- Sampling time:- <br /> Time <br /> ime:Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: •a Lock: r .,< <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: ' • <br />