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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6 <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MWS__ <br /> Lodz 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? NO <t5 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" EMCO 81e BK <br /> 12" BK 12" DWP'_:�( _ 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: _-�<12" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:_ e 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: 6 Zy Time: /off! Calculated purge: L4,JnW <br /> Depth of well : 76 61 Depth to water: 6 3, 79 Actual purge: u./ <br /> Depth to water: C3,0 <br /> Start purge: G3 7 Sampling time: /aha <br /> Time Temp. E. C. pH Turbidity Volume <br /> 9 y a <br /> 61W ---------- <br /> 6 Z? <br /> -6Z? /207 7/0 <br /> s S ice;4 2 <br /> Sample appearance: C_L2t___ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: .��_^�-� <br />