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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: - <br /> 25 <br /> Lodi, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? U5 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) : 11 <br /> Wel l cover type: 811 UV 1211 UV 1211 EMCO 811 BK <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: 211 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: 6 Time: �.1< Calculated purge _ <br /> iDepth of well: Depth to water: 613 9 I Actual purge:3 'i <br /> Depth to water: <br /> Start purge: /1.00 Sampling time: /a3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> �-)_t /O 73 2 z <br /> r 7 <br /> Sample appearance: Lock: r'z <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2f1 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 />