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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon 2695 -� Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 17 <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? ID If no, see remarks <br /> Is well cap sealed and locked? O E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 W 121T1211 12" EMCO 8'0 BK <br /> 12'4 BK 1211 DWP 1211 CNI X 3611 CNI Other <br /> General condition of wellhead assembly: Excellent ood 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_ ✓1 414 644 8Q0 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:_ 413 _ Time: a A ; _ Calculated purge: /. <br /> Depth of well: 69,&17 Depth to water—: D Actual purge:f.7 2 <br /> Depth to water: 4ir <br /> Start purge: 5�. sampling time: 338 <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: -fi_ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) :� <br /> Remarks: <br /> i <br /> Signature; A�e <br />