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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: �eZ`�-9 6 <br /> Site: Beacon x#695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW--1 0 <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? NO Above TOC aow C <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) : 3 <br /> Well cover type: 811 UV 12f1 UV 1211 EMCO 811 BK <br /> � 12'1 C <br /> 1211 BK 1211 DWP ' NI 3 611 CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: �2t1 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal 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: 6J 7 Time: &}-N Calculated purge: 4{2te/_ <br /> Depth of well: 6y. 75 Depth to water: 66,544 Actual purge: )- 6f � - <br /> Depth to water: 66.n s <br /> Start purge: 750 _ Sampling time: 8'd,6-- <br /> Time <br /> 'aTime Temp. E.C. pH Turbidity Volume <br /> 75! /L1- 73Z <br /> Sample appearance: Look: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: �� <br />