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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMP,TION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #69§ Project No. : 94-695-01 <br /> 9QO S Cherohea Lane Well Designation: -�- <br /> Lodi. <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O YES Above TOC Below TOC <br /> Is top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? A1� gf no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 1211 UV 12B 9KCO 8 00 BK- <br /> 12 19 <br /> K1219 BK 1200 DWP 12" CNI369° CNI ^� <br /> General condition of wellhead arseJJF <br /> Excellesi Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 209 PVC bailer Dedicated bailer <br /> 400 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2104 400 600 800 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.417 2 . 61 gal/ft. <br /> Initial Measurement Rec a Measurement <br /> Time: Coit Time: Calculated purge:— <br /> Depth of ate l l: 7 Y Depth to grater:b b rActua 1 purge: Li t <br /> Depth to water: 67,9-5 <br /> Start purge:. 3 5 Sampling time:_ 2-5 q — <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7J <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 210 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 410 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />