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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: .3 X47,9 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900- S. - Cherokee Lane Well Designation: MW- /g <br /> Lodi, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut Level? NO jD 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) : 6 <br /> Well cover type: 811 UV 1211 UV 1211 EMCO 8 11 BK <br /> 1211 BK 121' DWP -:�4 1210 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer CCentrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 211 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />*Time: E26Time: Rud Calculated purge:_ <br /> Depth of well: �9.3� Depth to water: 6511 Actual purge: 4 <br /> Depth to water: 6:� s_Z_____ <br /> Start purge: 01if Sampling time: I,Lo <br /> Time Temp. E.C. pH Turbidity Volume <br /> � � 7 ------ <br /> 2.4o <br /> 717 <br /> Sample appearance: Lock: � - - <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />