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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3-.2!9-21_ <br /> Site: Beacon #695 Project No. : 94-695-01--- <br /> 900 S. Cherokee Lane Well Designation:_�►_�w.�- <br /> Lodi, CA _ <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? 4W 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) : -6 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8 I BK <br /> 12" BK 12" DWP 12" CNI 36" CNIQt <br /> General condition of wellhead assembly: Excellen oher <br /> Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Y_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 /> iTime: 61y _ Time: r1g Calculated purge: /06S <br /> Depth of well: 10 Depth to water:_ 6 Actual purge:In 7 <br /> Depth to water: 66'',03 <br /> Start purge: 220 Sampling time:^i-.y <br /> Time Temp. E.C. pH Turbidity Volume <br /> 95 <br /> 755 '2_ <br /> Sample appearance: Lock: P <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 /> Remarks: <br /> Signature: <br />