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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- 3 4 <br /> Lodi, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? IRY 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 JEJ If no, see remarks <br /> Height of well casing riser (in inches) : 1-f <br /> Well cover type: 8" UV 12" UV 1211 EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI �' _ 3611 CNI ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer Teflon bailer: <br /> Well Diameter: 2" 41")( 6" 81" <br /> Purge Vol, Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> *e: /f.1- Time: //%r Calculated purge: <br /> th of well- C 1 Depth to water:__� .7 Actual purge: :-:,•.� ' <br /> Depth to water 5JL-5� <br /> Start purge: L 5 Sampling time:J15 <br /> Time Temp. E. C. pH Turbidity Volume <br /> �oL,� <br /> f 7Z ' <br /> Sample appearance: c��c�..{. Lock: <br /> Equipment replaced: - (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lack-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Oemarks: <br /> Signature: <br />