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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> • Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- d- D <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 0 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) : _ I <br /> Well cover type: 8" 12" UV 12" EMCO 8" BK <br /> 12" BK 1 12" DWP_f- 12" CNI 36" CNIOther— <br /> General condition of wellhead assembly: Excellent (Goo4 Fair Poor <br /> Purging Equipment: -'xj 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: :�L Teflon bailer: <br /> Well Diameter: 2" -,'(' 4" 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 .47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: J/ L-�Lj Time: 4/ 7 Calculated purge: <br /> Depth of well: 61 7/ Depth to water: L 7. D Actual purge: <br /> Depth to water: <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Ll <br /> Sample appearance: c -L_ Lock: <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 />