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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 349-9� <br /> Site: Beacon #695 Pro]ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-d P <br /> Lodi , CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? f4g 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) : 3 <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI _ 36" CNI Other <br /> assembly:General condition of wellhead Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer 4Z _Centrifugal pump <br /> Sampled with: Disposal bailer: 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: 7/J! Time: /1a-3 Calculated purge: <br /> Depth of well: 7671 Depth to water: 6 Actual purge: <br /> Depth to water• Cjj X ____ <br /> Start purge: 1059 Sampling time: /1-16 <br /> Time Temp. E.C. pH Turbidity Volume <br /> /1 e736 <br /> 0/ 67 / 7.z <br /> i 6�1 .L <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />