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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--�-l ! <br /> Lodi CA <br /> Is setup of traffic control devices required? 8 YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO IM� If no, see remarks <br /> Is well cap sealed and locked? NO v If no, see remarks <br /> Height of well casing riser (an inches) : t <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 3.511 CNI X her <br /> General condition of wellhead assembly: Excellent ffoo Fair Poor <br /> Purging Equipment: X 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailers Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4i 6" 811 <br /> Purge Vol. Multiplier: 0. 1.6 0. 65 1.47 2 . 61 gal/ft. <br />• Initial Measurement Recharge Measurement <br /> Time: 1 Time:., i Calculated purge: <br /> Depth of well: 76 55 Depth to water. 4 7 �4 Actual purge: <br /> Depth to water: 6 5 / <br /> Start purge: 1* 3E Sampling time: df <br /> Time Temp. E.C. pH Turbidity Volume <br /> 4/ o 76 Ll 13 710 1 <br /> -------------------- <br /> Sample appearance: Lock: =y <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Panned Allenhead (DWP) : <br /> Remarks: <br /> Signature: - - <br />