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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: Il 1-9'�1J <br /> Site: Beacon #695 _ Project No. : 4-695-0 <br /> 900 S. Cherokee LAA§ Well Designation: MW- -�-5 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NQ if no, see remarks <br /> Height of well casing riser (in inches) : �- <br /> We l l cover type: 80 UV 1290 UV 120 IMWW 80 BK <br /> 1211 BK 1211 DWP 12 99 CMI -)( 3 640 CNI� their' <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 20 disposable bailer Submersible pump <br /> 240 PVC bailer Dedicated bailer <br /> 440 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 240 400 600 84a <br /> Purge Vol. Multiplier: 0.^16 0.65 1. 47 2. 61 gal/ft. <br /> Initialeasureme 12echa ae Measurement <br /> Time: &=--� Time: )l� Calculated purge <br /> Depth of well: 5 1?,3 3 Depth to water: f 9.6 y Actua 1 purge: <br /> Depth to water: 65.9,? <br /> Start Purge: J 0 o Sampling time: 1 �- <br /> Time Temp. E.C. pH Turbidity Volume <br /> f ` f s �Z ly3�' int 2 <br /> 1 <br /> Sample appearance: <br /> Lock: ;a <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead• <br /> 419 Locking Cap: Lock-Dolphin: 9/1.6 Bolt: <br /> 611 Locking Cap: Pinned Alienhead (DWP) : <br /> Remarks: <br /> T <br /> Signature: <br />