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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar 101 Sampling Date: -� <br /> . Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <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? NO If no, see remarks <br /> Is well cap sealed and locked' N� If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP­V_ _ 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent o d Fair Poor <br /> Purging Equipment: 1-2" 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: C 140 _ Time: 3 Z>T Calculated purge: <br /> Depth of well: 4t Depth to water:�� �- c53 Actual purger_ <br /> Depth to water: 6j..4 <br /> Start purge: 0-W3 Sampling time: AO-'l <br /> Time Temp. E.C. pH Turbidity Volume <br /> i } a- <br /> 2 or 5 ?6 <br /> Ge /03 J <br /> Sample appearance: GP-+�t.g 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 Boit: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: 'I <br />