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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: C/-Z3 -16 <br /> Site: Beacon #695 Pro3ect No. : 94-695-01 <br /> goo S. Cherokee Lane Well Designation: MW- <br /> Lodi. CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? O YES Above TOC Below TOC <br /> Is top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 3. <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI_2C _ 36" CNI Other <br /> General condition of wellhead assembly: Excellentoo 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: 211 A- 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: //1-1- Time: ILL Calculated purge: <br /> Depth of well: Depth to water: jOJ- 6 Actual purge: <br /> Depth to water: 6 9.8:i <br /> Start purge: Sampling time: 2— 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> AUo 6 7J <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 /> Remarks: 00 g" <br /> Signature: <br /> I <br />