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DOQLOS ENVIRONMSltTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beamn 513 Project No. : 94-51"41 <br /> 401 W. Kettleman Ln. well Designation: -i <br /> Lodi. Q <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? V YES Above TOC Below TOC <br /> is top of casing cut level? NO 64rh If no, use remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well caging riser (in inches) : S <br /> Well cover type: B" UV12" W� 12" EMCO - 9" BK_ <br /> 12" H1( 12" DWP 12" CNI 36" CNY Other <br /> General condition of wellhead assembly: Excellent ov fair Poor <br /> Purging Equipment: disposable bailer Submersible pump <br /> " PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" )( 6^ 6" <br /> Purqe Vol. Multiplier: 0. 16 0.65 1.47 2.61 qal/ft. <br /> InitiMl sur Heasureigent <br /> Time: Tine: Calculated purge <br /> yL� <br /> Depth of well: 7 Depth to water: -L o Actual purge: <br /> ' 1} Depth to water:� 9 — <br /> Start purge:-1-5-01 sampling time: 102-6 <br /> Time Temp. E.C. pH Turbidity Volume <br /> /O o l. 70.) <br /> ro 0 67,6 q13 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753: 7/32 Allenhead: <br /> 4" Locking Caps. Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> signature: <br />