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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_ 6--l-t-76 <br /> Site: Beacon #696 Project No. : 94-696-01 <br /> 2448 West Kettleman Lane Well Designation:. MW- J-4- <br /> Lodi , <br /> W- J-4Lodi CA <br /> Is setup of traffic control devices required? 0 ' YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NOES 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 1411 CNI 36" CNz other <br /> General condition of wellhead assembly: Excellent ood 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: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6"4-- 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal./ft. <br /> Initial Measurement Recharge Measurement <br /> Time: J117 Time: 2a- Calculated purger + <br /> Depth of well:-649.J3 _ Depth to water: QC1,44y Actual purge: <br /> Depth to water: tl!R�_sJ <br /> Start purge: /�-I�t Sampling time: .5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 71-5 2 <br /> Sample appearance: ' 1. �n.r Lock: � s <br /> (CEeeck .all that apply) Note condition of replaced item. <br /> r.r :r•.'� i.'hT .`.x�`:_.. _.. .. t,u�•A /J7!�.Iz. '//:1:,2 A] 1cl�itc�.lciz <br /> -4 L.�•x.itey 6.'al+ 9/16 Bolt: <br /> 60 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />