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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon 695 Project No. : 94-695-01 <br /> 100-1 <br /> goo S. Cherokee Lane Well Designation: MW-30 _ <br /> 3 ,,_q l <br /> Lodi , CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 2 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 YZD If no, see remarks <br /> Height of well casing riser (an inches) : <br /> Well cover type: 8" UV 12" UV — 12-1" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI _ 36" CNI --other <br /> General condition of wellhead assembly: Excellent Gooj 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" 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />• Time: /10.1 Time: Calculated purger L <br /> Depth of well: 7 �- Depth to water: 3 Actual purge:_ /0 /1 <br /> Depth to water: jj`i i K <br /> Start purge:]- 36 Sampling time: k ir <br /> Time Temp. E.C. pH Turbidity Volume <br /> ►µa 3 3 753 / <br /> 14 3 7 <br /> Sample appearance: :7 .�-.� 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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> iRemarks: Atl-) .7-�ln <br /> Signature: <br />