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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: `1 d-3-C16 <br /> . Site: Beacon #695 _ Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee 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? a YES Above TOC Below TOC <br /> Is top of casing cut level? NO (ZD If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : _ 4 <br /> Well cover type: 811 W 1211 UV 1211 EMCO 811 BK <br /> 1211 BK 1211 DWP� �4 _ 12f1 CNI 3 611 CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer VCentrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 211_X_ <br /> 1f.1JX 411 611 899 <br /> Purge Vol. Multiplier: 0166 0. 65 1.47 2 . 61. gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 3S _ Time: ),-�4 Calculated purge: - <br /> Depth of well: 7 16 Depth to water: 6 2.62- Actual purge: •1 <br /> Depth to water:19 9 1 D <br /> Start purge: // S _ Sampling time: /X 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> SSS Z3J- 3)1 7 7 <br /> /15-7 1 .3 D �� 21 <br /> 12,01 <br /> Sample appearance: 4&4-n_ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4f1 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6f1 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: ey�z�ll <br />