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DOULO8 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3 S <br /> • Site: Beacon #695 Project No. : 94-695-0 <br /> 900 S. Cherokee Lane Well Designation: NW- A-1 <br /> Lodi , CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Mj 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) : It <br /> Well cover type: 8" UV12" UV 12" EMCO 81° BK <br /> 12" BK 12" DWP 4 12" CNI 36" 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" -)r 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: S1 K Time: 621-J Calculated purge: 3.3 <br /> Depth of well:_69: 4 ) __ Depth to water: A 3 60 Actual purge: 3,3 <br /> Depth to water: 6Jz.6 <br /> Start purge: /O/V___ Sampling time: /4 2 2- <br /> Time <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1915 '73 <br /> 74'1 3 <br /> )43 <br /> Sample appearance: <br /> 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 />