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•DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: ._ -� r 9 <br /> Site: Beacon #696 Project No. : 94-696-01 <br /> 2448 West Kettleman Lane Well Designation: MW- <br /> Lodi, CA <br /> Is setup of traffic control devices required? � 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 nosee remarks <br /> Is well cap sealed and locked? NO If no,, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" .EMCO 8" BK <br /> 12" BK 12" DWP 1211 CNI> 36" CNI Other <br /> General condition of wellhead assembly: Excellent ���'c@D 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: Disposal bailer: X Teflon bailer: <br /> Well Diameter: 2" 4"-k—, 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> DTime: l J•. 3 p Time: Calculated purge: �� G= <br /> epth of well: 00•UQ Depth to water: f0 - 13 Actual purge:_7 99 <br /> Depth to water• <br /> Start purge: - 0 7 Sampling time: r . 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> t , to 5/ 75 7r t <br /> S3 � y 7yf 1 <br /> 5.3. / 6' 7. 3-5 21 <br /> = � 53 . 1 G S8 73 � <br /> Sample appearance: -{ u•Ci" Y 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 />