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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 2-3 9 7_ <br /> . Site: Beacon ,1695 _ Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-- 15 <br /> Lod i . CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O 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 YV If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI �(' 36" CNI Other <br /> General condition of wellhead assembly: Excellent �d 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: N:�r Teflon bailer: <br /> Well Diameter: 2111, 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ILL 7 Time: 317 Calculated purge:_��,. <br /> Depth of well: 3 fl Depth to water: 64 :Z_�' , Actual purge: 1f <br /> Depth to water: 2- <br /> Start <br /> Start purge: 2-x-4 Sampling time: I 9 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7G3 Ml) > - I <br /> 'f <br /> 1 - f <br /> Sample appearance: - Lock: 3 �5 ; <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 />