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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- � - <br /> Lodi-,- CA <br /> Is setup of traffic control devices required? N66 YES time: hours <br /> Is there standing water in well box? NO ove _ Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO ZCEX7 If no, see remarks <br /> Height of well casing riser (in inches) : Y9 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK-- -- <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent C-c�o 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:_ Teflon bailer: <br /> Well Diameter: 2" 401 X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Bechar a easurement <br /> W <br /> ime: �� 3 O Time:�= s Calculated purge: f y <br /> epth of well: 57 3�2j Depth to water: .S0-_31 Actual purge: R <br /> Depth to water: <br /> Start purge: - Sampling time: � � 9 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 71 <br /> 15� L <br /> Sample appearance: ('. l-'C. 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 /> l <br /> f� V -•-- <br /> Signature: <br />