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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: Z-- ? 7 <br />• Site: Beacon #695Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 2- <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? NO1W If no, see remarks <br /> Is well cap sealed and locked? NOIf no, see remarks <br /> Height of well casing riser (in inches) : W <br /> Well cover type: $" UV 12" UV 12" EMCO $" BK <br /> 12" BK 12" DWP 12" CNIX 36" CNI Other <br /> General condition of wellhead assembly: Excellent G 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" Err 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: /i3,r Time: i 6K, Calculated purge: 2- <br /> Depth <br /> Depth of well : 7t ,64 Depth to water:_ b � Nn Actual purge:_ �- <br /> Depth to water: <br /> Start purge: Sampling time:_3 0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> �'_ 7C� ,_ I 7 726 <br /> 76 <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: <br />