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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: MW- '25 <br /> Lodi,_ CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO ?_ r If no, see remarks <br /> Height of well casing riser (in inches) : 6 <br /> Well cover type: 8" W 12" W 121' EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI X Other <br /> General condition of wellhead assembly: Excellent - oo Fair Poor <br /> Purging Equipment: X2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:—/< Teflon bailer: <br /> Well Diameter: 2" 4+1 Err4 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement .� <br /> Time: 1 : C) Time: �" 5-3 .,39 <br /> Calculated purge: �- <br /> Wepth of well• Sof 3� Depth to water• -�3 •$ 9 Actual purge: 1 a �C- <br /> Depth to water: 3 <br /> Start purge: 3 Sampling time: 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> Lq_ 1 53 . 7 S 7- .ql f <br /> Sample appearance: G '� 'L���^ Lock: <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 />