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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_ <br /> Site: Beacon #696 _ Project No. : 94-696-01 <br /> 2448 West Kettleman Lane Well Designation: -.13A <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 12 YES Above TOC Below TOC <br /> Is top of casing cut level? NO JrD If no, see remarks <br /> Is well cap sealed and locked? NO Q0 If no, see remarks <br /> Height of well casing riser (in inches) : 6 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI k _ 36" CNI ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 8211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4"-A— 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ), Time: 15 JA Calculated purge: 3- <br /> Depth of well: 5749. 5 CJ Depth to r:wate5b,0 Actual purge: <br /> Depth to water: Wl•i3 <br /> Start purge: /1147 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 5'3 1 6"1-.5 71 CJ ---�_ �- <br /> Sample appearance: Lock: 3753 <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: _,24Z - _ . <br />