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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ow <br /> Client: Ultramar Sampling Date: 3 a <br /> • Site: Beacon X695 _ Project No. : 94-695-01 <br /> 900_ S. Cherokee Lane Well Designation: MW-d-3 <br /> Lodi, CA <br /> Is setup of traffic control devices required? !O XzS time: ho rs <br /> Is there standing water in well box? NO iQDS Above TOC BeNLow T <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N E If no, see remarks <br /> Height of well casing riser (in inches) <br /> Well cover type: B" UV 1211 UV 1211 EMCO 814 BK <br /> 1211 BK 1211 DWP�Y 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: k211 disposable bailer Submersible pump <br /> 2f1 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2"_-? 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0, 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />•Time: 643 Time:_ /b-')- Calculated purge: <br /> Depth of well—: 6E61 Depth to water: 63A-3 _ Actual purge: '• <br /> Depth to water: 63,11 <br /> Start purge: IN-7 Sampling time: !b 63 <br /> Time Temp. E. C. pH Turbidity Volume <br /> i0 J4, 6 <br /> 103 u / /.J-+J 74- <br /> 103 7 <br /> Sample appearance: Lock: 13 253 <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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />