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i <br /> DOIILOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Of <br /> Client: Ultramar Sampling Date; <br /> Site: Beacon 1696 Project No. : 94--696-01 <br /> 2448 West Kettleman Lane Well Designation:^ MW-JE <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 ila If no, see remarks <br /> Is well cap sealed and locked? NO � If no, see remarks <br /> Height of well casing riser (in inches) :Well cover type: S" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNIk �" CNI Other <br /> General condition of wellhead assembly: Celle Good 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 :_-V Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> e: 111i4 Time: Calculated purge: / <br /> th of well: l '; Depth to water: 1 Actual purge: <br /> Depth to water: 5:.�- <br /> Start purge:_-L10-`- Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance; 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 /> emarks: <br /> Signature: <br />