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DOULO$ ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: Z' <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 3-3 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level' NO M If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : !4 <br /> Well cover type: 8" UV 12" UV 12 ' EMCO 8" BIi <br /> 12" BK 12" DWP 12" CNI 36" CNI tether <br /> General condition of wellhead assembly: Excellent r5bo ) 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: 211 <br /> —.L 4" 6" 8" <br /> l <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: I>-Oi 11 Time: Calculated purge: <br /> Depth of well: C5 �� Depth to water: Actual purge: <br /> Depth to water: S3 5 J <br /> Start purge: L 1-3 Sampling time: S.3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1433 - - — � <br /> Sample appearance: E= 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 /> r <br /> signature: <br />