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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3-J- 7-16 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- .5* <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? NO 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: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI36" CNI ther <br /> General condition of wellhead assembly: Excellent 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"--y- 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Wepth <br /> ime: 7/3- _ Time: �7 Calculated purge:of well 66,3 . Depth to water: 6 ri- Actual purge: / �- <br /> Depth to water• �'�r 5 <br /> Start purge: 3!f h Sampling time:_ <br /> Time Temp. E.C. pH Turbidity Volume <br /> Ll 7/1- i z <br /> J! / a <br /> 3 q 6 S a 7 2 5 <br /> E L <br /> Sample appearance: y�kAg, '\ 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 />