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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: h)-J-% <br /> Site:, Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: XW-AW`-a' <br /> Lodi.. CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? % Y 9,9 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) : Ib <br /> Well cover type: 8f1 UV 1211 UV 1211 EMCO 819 BK <br /> 1211 BK 1211 DWP 121' CNI 3 619 CNI* Other <br /> General condition of wellhead assembly: Excellent o 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 41' 611 $1' <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 6.�.0 Time: 42-3 _ Calculated purge: . / <br /> Depth of well: / _ Depth to water: Actual purge: 6Q4,2 <br /> Depth to water: 6u.fQ <br /> Start purge: eJO Sampling time: C12 V <br /> Time Temp. E.C. pH Turbidity Volume <br /> 14 <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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6t1 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />