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DOULOS E"IRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon 4695 Project No. : 94-695-01 _ <br /> 900 S, Charokag Lane Well Designation: NW--L;k _ <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? I YES Above TOC Below TOC <br /> Is top of casing cut level? NO iffk if no, see remarks <br /> Is well cap sealed and locked? ATO If no, see remarks <br /> Height of well casing riser (in inches) : 6 <br /> Well cover type: 80 U% 12w UV 120 EKCO T 800 BK <br /> 1210 BK 1210 DWP -�' 1240 CNI 360 CNI Other <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 200 disposable bailer Submersible pump <br /> 200 PVC bailer Dedicated bailer <br /> 4401 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" k 4411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> initial Measurement Regbarg Measurement <br /> Time: E/- Time: Calculated purge: ^S %'' <br /> Depth of cae 11: aZL2,r�-- Depth to mater: 5 ' y Actual purge: <br /> Depth to water: (56 06 <br /> Start t)urge: Sampling time:_42! <br /> Time Temp. i E.C. pH Turbidity Volume <br /> 3 --�- ' <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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> J ; r <br /> Signature: <br />