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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3.1114AE <br /> Site: Beacon #695 Pro3ect No. :---94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-30 <br /> Lodi. CA <br /> Is setup of traffic control devices required? O 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 E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI X 36" CNI then <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" 4It.� ger Sit <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 613 Time: 1-190 _ Calculated purge: 3 <br /> Depth of well-2'2, / 7 Depth to water:�L ob Actual purge: 3/,e <br /> Depth to water: 64g5 <br /> Start purge: IZlS Sampling time: 115 7 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7/0 �� ! <br /> 76 ) <br /> J Ar <br /> Sample appearance: 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: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> is Remarks: <br /> Signature: <br />