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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> 1111110 <br /> Client: Ultramar Sampling Date: 3d-c?- q6 <br /> Site: Beacon X695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-19 <br /> Lodi . CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 3 YES Above TOC Below TOC <br /> Is top of casing cut level? NO EM If no, see remarks <br /> Is well cap sealed and locked? NO � If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP X211 CNI�_ 36" CNI Other <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" 4"•y _ 6" all <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />.Time• yi 7 Time• Lai-- Calculated purge: 3 4 <br /> Depth of well: 76 76 Depth to water*n :6 Ui Actual purge: ! <br /> Depth to water: G 14G!d <br /> Start purge: IJ-30 Sampling time: 243 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 14E '4 IY3/ 711 � <br /> 7/0 <br /> 70? j <br /> Sample appearance: CAif 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: 6 <br /> Pinned Allenhead (DWP) : <br /> 6" Locking Cap: <br /> Remarks: <br /> Signature: J <br />