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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: q" D3` 11 <br />. Site: Beacon #695 Pro]ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-.19 <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? V If no, see remarks <br /> Is well cap sealed and locked? NO q0 If no, see remarks <br /> Height of well casing riser (in inches) : � U <br /> Well cover type: 8" W 12" UV 12" EMCO 811 BIC <br /> 12" BK 12" DWP 12" CNIj' CNIA' ther <br /> General condition of wellhead assembly: Exc�ellent oo 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" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: IIDa _ Time: Calculated purge: 7 d <br /> Depth of well: 16 6 jj _ Depth to water: 7D.CD Actual purge: <br /> Depth to water: 6e- F6 <br /> Start purge: ! Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> ILS-3 3 ------ / <br /> n 4 <br /> Lj <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: <br /> Signature: <br />