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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- aL- <br /> Lodi . CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? �O Y S Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : . <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP s/' 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent ovoc 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" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> . Initial Measurement Recharge Measurement_ <br /> Time: r; L+-' Time: "I Calculated purge: <br /> Depth of well:- I—) Depth to water: Actual purge: <br /> Depth to water: 6w 1- / <br /> Start purge: Sampling time: rr <br /> Time Temp. E.C. pH Turbidity Volume <br /> r <br /> Sample appearance: 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: A <br />