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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 /> 900 S. Cherokee Lane Well Designation: NW- 17 <br /> Lodi, CA <br /> Is setup of traffic control devices required? qb YES time: hours <br /> Is there standing water in well box? Vg 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) : <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI36" CNI Other <br /> General condition of wellhead assemb y• 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" 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- q Time: - z-37 Calculated purge: . <br />• <br /> Depth of well_: 69.51 Depth to water: CS O Actual purge: A4 •� <br /> Depth to water: B3' DS <br /> Start purge: 2 Zj Sampling time: 1- <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2 6L z <br /> �L7 <br /> 0 6� <br /> Sample appearance: Lock: c- - <br /> I <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 /> I <br /> j� <br /> signature: <br />