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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: UltramarSampling Date: �`3 -� <br /> • Site: Beacon jf695 Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: - Aw-cl <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 6 <br /> Well cover type: 8" UV 12" UV 1.2" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNIY� Other <br /> General condition of wellhead assembly: Excellent' GS-0-1 Fair Poor <br /> Purging Equipment: _ 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: X 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: 1Zu5 Time: 2--w(" - <br /> purge:._! 02 <br /> Depth of well: Depth to water: � ��37 Actual purge:_ <br /> Depth to water: ?1. 51 <br /> Start purge: )-014 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> /y 62. 730 <br /> jL� L �ZS' <br /> Sample appearance: _ -�' _ Lock: <br /> i. <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 />